|
CHG RADEX HUMERUS MINIMUM 2 VIEWS
|
Professional
|
$32.83
|
|
|
Service Code
|
HCPCS 73060 26
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$104.32 |
| Rate for Payer: Cash Price |
$8.56
|
| Rate for Payer: Cash Price |
$8.56
|
| 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 INTERNAL AUDITORY MEATI COMPLETE
|
Professional
|
$262.26
|
|
|
Service Code
|
HCPCS 70134
|
| Min. Negotiated Rate |
$13.66 |
| Max. Negotiated Rate |
$196.70 |
| Rate for Payer: Cash Price |
$72.05
|
| Rate for Payer: Cash Price |
$72.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$67.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$67.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$71.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$74.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$71.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$74.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$56.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$71.18
|
| Rate for Payer: Healthfirst QHP |
$74.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$52.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$74.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$63.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$52.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$74.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$196.70
|
| Rate for Payer: SOMOS Essential |
$196.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$74.93
|
|
|
CHG RADEX INTERNAL AUDITORY MEATI COMPLETE
|
Professional
|
$193.94
|
|
|
Service Code
|
HCPCS 70134 TC
|
| Min. Negotiated Rate |
$13.66 |
| Max. Negotiated Rate |
$196.70 |
| Rate for Payer: Cash Price |
$53.28
|
| Rate for Payer: Cash Price |
$53.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$49.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$49.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$52.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$55.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$52.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$52.64
|
| Rate for Payer: Healthfirst QHP |
$55.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$38.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$55.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$47.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$38.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$55.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$145.46
|
| Rate for Payer: SOMOS Essential |
$145.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.41
|
|
|
CHG RADEX INTERNAL AUDITORY MEATI COMPLETE
|
Professional
|
$68.32
|
|
|
Service Code
|
HCPCS 70134 26
|
| Min. Negotiated Rate |
$13.66 |
| Max. Negotiated Rate |
$196.70 |
| Rate for Payer: Cash Price |
$18.77
|
| Rate for Payer: Cash Price |
$18.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.54
|
| Rate for Payer: Healthfirst QHP |
$19.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$51.24
|
| Rate for Payer: SOMOS Essential |
$51.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.52
|
|
|
CHG RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS
|
Professional
|
$104.79
|
|
|
Service Code
|
HCPCS 73592 TC
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$102.14 |
| 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 LOWER EXTREMITY INFANT MINIMUM 2 VIEWS
|
Professional
|
$31.40
|
|
|
Service Code
|
HCPCS 73592 26
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$102.14 |
| 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 LOWER EXTREMITY INFANT MINIMUM 2 VIEWS
|
Professional
|
$136.19
|
|
|
Service Code
|
HCPCS 73592
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$102.14 |
| Rate for Payer: Cash Price |
$37.09
|
| Rate for Payer: Cash Price |
$37.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.96
|
| Rate for Payer: Healthfirst QHP |
$38.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$102.14
|
| Rate for Payer: SOMOS Essential |
$102.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.91
|
|
|
CHG RADEX MASTOIDS COMPL MINIMUM 3 VIEWS PR SIDE
|
Professional
|
$201.11
|
|
|
Service Code
|
HCPCS 70130 TC
|
| Min. Negotiated Rate |
$13.35 |
| Max. Negotiated Rate |
$200.90 |
| Rate for Payer: Cash Price |
$54.46
|
| Rate for Payer: Cash Price |
$54.46
|
| 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 MASTOIDS COMPL MINIMUM 3 VIEWS PR SIDE
|
Professional
|
$66.75
|
|
|
Service Code
|
HCPCS 70130 26
|
| Min. Negotiated Rate |
$13.35 |
| Max. Negotiated Rate |
$200.90 |
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.12
|
| Rate for Payer: Healthfirst QHP |
$19.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$50.06
|
| Rate for Payer: SOMOS Essential |
$50.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.07
|
|
|
CHG RADEX MASTOIDS COMPL MINIMUM 3 VIEWS PR SIDE
|
Professional
|
$267.86
|
|
|
Service Code
|
HCPCS 70130
|
| Min. Negotiated Rate |
$13.35 |
| Max. Negotiated Rate |
$200.90 |
| Rate for Payer: Cash Price |
$72.28
|
| Rate for Payer: Cash Price |
$72.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$68.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$68.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$72.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$76.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$72.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$76.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$72.70
|
| Rate for Payer: Healthfirst QHP |
$76.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$53.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$76.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$65.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$53.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$76.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$200.90
|
| Rate for Payer: SOMOS Essential |
$200.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$76.53
|
|
|
CHG RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS
|
Professional
|
$130.69
|
|
|
Service Code
|
HCPCS 70160 TC
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$123.58 |
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.47
|
| Rate for Payer: Healthfirst QHP |
$37.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$37.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$31.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$98.02
|
| Rate for Payer: SOMOS Essential |
$98.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.34
|
|
|
CHG RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS
|
Professional
|
$34.09
|
|
|
Service Code
|
HCPCS 70160 26
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$123.58 |
| Rate for Payer: Cash Price |
$8.91
|
| Rate for Payer: Cash Price |
$8.91
|
| 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 NASAL BONES COMPLETE MINIMUM 3 VIEWS
|
Professional
|
$164.78
|
|
|
Service Code
|
HCPCS 70160
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$123.58 |
| Rate for Payer: Cash Price |
$44.12
|
| Rate for Payer: Cash Price |
$44.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$42.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$44.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$44.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$44.73
|
| Rate for Payer: Healthfirst QHP |
$47.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$47.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$40.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$123.58
|
| Rate for Payer: SOMOS Essential |
$123.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.08
|
|
|
CHG RADEX OPTIC FORAMINA
|
Professional
|
$161.14
|
|
|
Service Code
|
HCPCS 70190
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$120.86 |
| Rate for Payer: Cash Price |
$43.94
|
| Rate for Payer: Cash Price |
$43.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$41.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$43.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43.74
|
| Rate for Payer: Healthfirst QHP |
$46.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$46.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$39.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$120.86
|
| Rate for Payer: SOMOS Essential |
$120.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.04
|
|
|
CHG RADEX OPTIC FORAMINA
|
Professional
|
$43.40
|
|
|
Service Code
|
HCPCS 70190 26
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$120.86 |
| Rate for Payer: Cash Price |
$11.88
|
| Rate for Payer: Cash Price |
$11.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.78
|
| Rate for Payer: Healthfirst QHP |
$12.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$12.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$10.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.55
|
| Rate for Payer: SOMOS Essential |
$32.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.40
|
|
|
CHG RADEX OPTIC FORAMINA
|
Professional
|
$117.74
|
|
|
Service Code
|
HCPCS 70190 TC
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$120.86 |
| Rate for Payer: Cash Price |
$32.06
|
| Rate for Payer: Cash Price |
$32.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.96
|
| Rate for Payer: Healthfirst QHP |
$33.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$33.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$88.30
|
| Rate for Payer: SOMOS Essential |
$88.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.64
|
|
|
CHG RADEX ORBITS COMPLETE MINIMUM 4 VIEWS
|
Professional
|
$204.40
|
|
|
Service Code
|
HCPCS 70200
|
| Min. Negotiated Rate |
$10.72 |
| Max. Negotiated Rate |
$153.30 |
| Rate for Payer: Cash Price |
$55.81
|
| Rate for Payer: Cash Price |
$55.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$52.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$52.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$55.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$58.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$55.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$58.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$58.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$55.48
|
| Rate for Payer: Healthfirst QHP |
$58.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$40.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$58.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$49.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$40.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$58.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$153.30
|
| Rate for Payer: SOMOS Essential |
$153.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$58.40
|
|
|
CHG RADEX ORBITS COMPLETE MINIMUM 4 VIEWS
|
Professional
|
$53.62
|
|
|
Service Code
|
HCPCS 70200 26
|
| Min. Negotiated Rate |
$10.72 |
| Max. Negotiated Rate |
$153.30 |
| Rate for Payer: Cash Price |
$14.71
|
| Rate for Payer: Cash Price |
$14.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.55
|
| Rate for Payer: Healthfirst QHP |
$15.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$10.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$15.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$13.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$10.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.22
|
| Rate for Payer: SOMOS Essential |
$40.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.32
|
|
|
CHG RADEX ORBITS COMPLETE MINIMUM 4 VIEWS
|
Professional
|
$150.82
|
|
|
Service Code
|
HCPCS 70200 TC
|
| Min. Negotiated Rate |
$10.72 |
| Max. Negotiated Rate |
$153.30 |
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cash Price |
$41.10
|
| 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 PHARYNX/LARX W/FLUOR&/MAGNIFICATION TQ
|
Professional
|
$369.29
|
|
|
Service Code
|
HCPCS 70370 TC
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$321.93 |
| Rate for Payer: Cash Price |
$106.32
|
| Rate for Payer: Cash Price |
$106.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$97.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$97.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$102.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$107.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$102.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$107.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$102.58
|
| Rate for Payer: Healthfirst QHP |
$107.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$75.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$107.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$91.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$75.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$107.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$276.97
|
| Rate for Payer: SOMOS Essential |
$276.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$107.98
|
|
|
CHG RADEX PHARYNX/LARX W/FLUOR&/MAGNIFICATION TQ
|
Professional
|
$429.24
|
|
|
Service Code
|
HCPCS 70370
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$321.93 |
| Rate for Payer: Cash Price |
$123.06
|
| Rate for Payer: Cash Price |
$123.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$112.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$112.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$118.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$125.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$118.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$93.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$118.84
|
| Rate for Payer: Healthfirst QHP |
$125.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$87.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$125.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$106.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$87.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$125.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$321.93
|
| Rate for Payer: SOMOS Essential |
$321.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$125.10
|
|
|
CHG RADEX PHARYNX/LARX W/FLUOR&/MAGNIFICATION TQ
|
Professional
|
$59.92
|
|
|
Service Code
|
HCPCS 70370 26
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$321.93 |
| Rate for Payer: Cash Price |
$16.73
|
| Rate for Payer: Cash Price |
$16.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.26
|
| Rate for Payer: Healthfirst QHP |
$17.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$17.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$14.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$44.94
|
| Rate for Payer: SOMOS Essential |
$44.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.12
|
|
|
CHG RADEX RENAL CYST STUDY TRANSLUMBAR RS&I
|
Professional
|
$253.09
|
|
|
Service Code
|
HCPCS 74470 TC
|
| Min. Negotiated Rate |
$20.60 |
| Max. Negotiated Rate |
$267.07 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$189.82
|
| Rate for Payer: SOMOS Essential |
$189.82
|
|
|
CHG RADEX RENAL CYST STUDY TRANSLUMBAR RS&I
|
Professional
|
$356.09
|
|
|
Service Code
|
HCPCS 74470
|
| Min. Negotiated Rate |
$20.60 |
| Max. Negotiated Rate |
$267.07 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$267.07
|
| Rate for Payer: SOMOS Essential |
$267.07
|
|
|
CHG RADEX RENAL CYST STUDY TRANSLUMBAR RS&I
|
Professional
|
$103.01
|
|
|
Service Code
|
HCPCS 74470 26
|
| Min. Negotiated Rate |
$20.60 |
| Max. Negotiated Rate |
$267.07 |
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.96
|
| Rate for Payer: Healthfirst QHP |
$29.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$25.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$77.26
|
| Rate for Payer: SOMOS Essential |
$77.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.43
|
|
