|
CHG RADEX RIBS BILATERAL 3 VIEWS
|
Professional
|
$54.88
|
|
|
Service Code
|
HCPCS 71110 26
|
| Min. Negotiated Rate |
$10.98 |
| Max. Negotiated Rate |
$140.23 |
| Rate for Payer: Cash Price |
$15.06
|
| Rate for Payer: Cash Price |
$15.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.90
|
| Rate for Payer: Healthfirst QHP |
$15.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$10.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$15.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$13.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$10.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$41.16
|
| Rate for Payer: SOMOS Essential |
$41.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.68
|
|
|
CHG RADEX RIBS BILATERAL 3 VIEWS
|
Professional
|
$186.97
|
|
|
Service Code
|
HCPCS 71110
|
| Min. Negotiated Rate |
$10.98 |
| Max. Negotiated Rate |
$140.23 |
| Rate for Payer: Cash Price |
$51.05
|
| Rate for Payer: Cash Price |
$51.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$48.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$48.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$53.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$50.75
|
| Rate for Payer: Healthfirst QHP |
$53.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$53.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$45.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$53.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$140.23
|
| Rate for Payer: SOMOS Essential |
$140.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.42
|
|
|
CHG RADEX RIBS BILATERAL 3 VIEWS
|
Professional
|
$132.13
|
|
|
Service Code
|
HCPCS 71110 TC
|
| Min. Negotiated Rate |
$10.98 |
| Max. Negotiated Rate |
$140.23 |
| Rate for Payer: Cash Price |
$35.99
|
| Rate for Payer: Cash Price |
$35.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.86
|
| Rate for Payer: Healthfirst QHP |
$37.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$37.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$99.10
|
| Rate for Payer: SOMOS Essential |
$99.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.75
|
|
|
CHG RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS
|
Professional
|
$225.09
|
|
|
Service Code
|
HCPCS 71111
|
| Min. Negotiated Rate |
$12.56 |
| Max. Negotiated Rate |
$168.82 |
| Rate for Payer: Cash Price |
$61.37
|
| Rate for Payer: Cash Price |
$61.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$57.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$57.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$61.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$64.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$61.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$64.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$64.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$48.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.09
|
| Rate for Payer: Healthfirst QHP |
$64.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$64.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$54.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$64.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$168.82
|
| Rate for Payer: SOMOS Essential |
$168.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$64.31
|
|
|
CHG RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS
|
Professional
|
$162.30
|
|
|
Service Code
|
HCPCS 71111 TC
|
| Min. Negotiated Rate |
$12.56 |
| Max. Negotiated Rate |
$168.82 |
| Rate for Payer: Cash Price |
$44.24
|
| Rate for Payer: Cash Price |
$44.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$41.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$44.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$44.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$44.05
|
| Rate for Payer: Healthfirst QHP |
$46.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$46.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$39.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$121.72
|
| Rate for Payer: SOMOS Essential |
$121.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.37
|
|
|
CHG RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS
|
Professional
|
$62.79
|
|
|
Service Code
|
HCPCS 71111 26
|
| Min. Negotiated Rate |
$12.56 |
| Max. Negotiated Rate |
$168.82 |
| Rate for Payer: Cash Price |
$17.13
|
| Rate for Payer: Cash Price |
$17.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.04
|
| Rate for Payer: Healthfirst QHP |
$17.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$12.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$17.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$15.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$12.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.09
|
| Rate for Payer: SOMOS Essential |
$47.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.94
|
|
|
CHG RADEX RIBS UNILATERAL 2 VIEWS
|
Professional
|
$114.87
|
|
|
Service Code
|
HCPCS 71100 TC
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$118.58 |
| 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 RIBS UNILATERAL 2 VIEWS
|
Professional
|
$158.10
|
|
|
Service Code
|
HCPCS 71100
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$118.58 |
| Rate for Payer: Cash Price |
$42.72
|
| Rate for Payer: Cash Price |
$42.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$42.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$45.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$42.91
|
| Rate for Payer: Healthfirst QHP |
$45.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$45.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$38.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$45.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$118.58
|
| Rate for Payer: SOMOS Essential |
$118.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.17
|
|
|
CHG RADEX RIBS UNILATERAL 2 VIEWS
|
Professional
|
$43.23
|
|
|
Service Code
|
HCPCS 71100 26
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$118.58 |
| Rate for Payer: Cash Price |
$11.44
|
| Rate for Payer: Cash Price |
$11.44
|
| 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 RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS
|
Professional
|
$129.22
|
|
|
Service Code
|
HCPCS 71101 TC
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$135.14 |
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.07
|
| Rate for Payer: Healthfirst QHP |
$36.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$36.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$31.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$96.92
|
| Rate for Payer: SOMOS Essential |
$96.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.92
|
|
|
CHG RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS
|
Professional
|
$50.93
|
|
|
Service Code
|
HCPCS 71101 26
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$135.14 |
| Rate for Payer: Cash Price |
$13.97
|
| Rate for Payer: Cash Price |
$13.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.82
|
| Rate for Payer: Healthfirst QHP |
$14.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$10.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$14.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$12.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$10.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$38.20
|
| Rate for Payer: SOMOS Essential |
$38.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.55
|
|
|
CHG RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS
|
Professional
|
$180.18
|
|
|
Service Code
|
HCPCS 71101
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$135.14 |
| Rate for Payer: Cash Price |
$49.17
|
| Rate for Payer: Cash Price |
$49.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$46.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$46.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$48.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$51.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$48.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$48.91
|
| Rate for Payer: Healthfirst QHP |
$51.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$51.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$43.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$51.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$135.14
|
| Rate for Payer: SOMOS Essential |
$135.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$51.48
|
|
|
CHG RADEX SACRUM & COCCYX MINIMUM 2 VIEWS
|
Professional
|
$106.23
|
|
|
Service Code
|
HCPCS 72220 TC
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$105.24 |
| 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
|
|
|
CHG RADEX SACRUM & COCCYX MINIMUM 2 VIEWS
|
Professional
|
$34.09
|
|
|
Service Code
|
HCPCS 72220 26
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$105.24 |
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.25
|
| Rate for Payer: Healthfirst QHP |
$9.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.57
|
| Rate for Payer: SOMOS Essential |
$25.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.74
|
|
|
CHG RADEX SACRUM & COCCYX MINIMUM 2 VIEWS
|
Professional
|
$140.32
|
|
|
Service Code
|
HCPCS 72220
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$105.24 |
| Rate for Payer: Cash Price |
$38.22
|
| Rate for Payer: Cash Price |
$38.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.09
|
| Rate for Payer: Healthfirst QHP |
$40.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$40.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$105.24
|
| Rate for Payer: SOMOS Essential |
$105.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.09
|
|
|
CHG RADEX SCAPULA COMPLETE
|
Professional
|
$101.50
|
|
|
Service Code
|
HCPCS 73010
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$76.12 |
| Rate for Payer: Cash Price |
$28.01
|
| Rate for Payer: Cash Price |
$28.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.55
|
| Rate for Payer: Healthfirst QHP |
$29.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$76.12
|
| Rate for Payer: SOMOS Essential |
$76.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.00
|
|
|
CHG RADEX SCAPULA COMPLETE
|
Professional
|
$35.53
|
|
|
Service Code
|
HCPCS 73010 26
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$76.12 |
| Rate for Payer: Cash Price |
$9.70
|
| Rate for Payer: Cash Price |
$9.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.64
|
| Rate for Payer: Healthfirst QHP |
$10.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$7.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$10.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.65
|
| Rate for Payer: SOMOS Essential |
$26.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.15
|
|
|
CHG RADEX SCAPULA COMPLETE
|
Professional
|
$65.98
|
|
|
Service Code
|
HCPCS 73010 TC
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$76.12 |
| Rate for Payer: Cash Price |
$18.31
|
| Rate for Payer: Cash Price |
$18.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.91
|
| Rate for Payer: Healthfirst QHP |
$18.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$18.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$49.48
|
| Rate for Payer: SOMOS Essential |
$49.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.85
|
|
|
CHG RADEX SHOULDER 1 VIEW
|
Professional
|
$93.28
|
|
|
Service Code
|
HCPCS 73020
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$69.96 |
| Rate for Payer: Cash Price |
$25.34
|
| Rate for Payer: Cash Price |
$25.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.32
|
| Rate for Payer: Healthfirst QHP |
$26.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$26.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.96
|
| Rate for Payer: SOMOS Essential |
$69.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.65
|
|
|
CHG RADEX SHOULDER 1 VIEW
|
Professional
|
$63.11
|
|
|
Service Code
|
HCPCS 73020 TC
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$69.96 |
| Rate for Payer: Cash Price |
$17.13
|
| Rate for Payer: Cash Price |
$17.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.13
|
| Rate for Payer: Healthfirst QHP |
$18.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$12.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$18.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$15.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$12.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.33
|
| Rate for Payer: SOMOS Essential |
$47.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.03
|
|
|
CHG RADEX SHOULDER 1 VIEW
|
Professional
|
$30.14
|
|
|
Service Code
|
HCPCS 73020 26
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$69.96 |
| Rate for Payer: Cash Price |
$8.21
|
| Rate for Payer: Cash Price |
$8.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.18
|
| Rate for Payer: Healthfirst QHP |
$8.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22.60
|
| Rate for Payer: SOMOS Essential |
$22.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.61
|
|
|
CHG RADEX SHOULDER ARTHROGRAPHY RS&I
|
Professional
|
$565.74
|
|
|
Service Code
|
HCPCS 73040
|
| Min. Negotiated Rate |
$22.04 |
| Max. Negotiated Rate |
$424.30 |
| Rate for Payer: Cash Price |
$153.75
|
| Rate for Payer: Cash Price |
$153.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$145.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$145.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$153.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$161.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$153.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$161.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$161.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$121.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$153.56
|
| Rate for Payer: Healthfirst QHP |
$161.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$113.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$161.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$137.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$113.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$161.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$424.30
|
| Rate for Payer: SOMOS Essential |
$424.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$161.64
|
|
|
CHG RADEX SHOULDER ARTHROGRAPHY RS&I
|
Professional
|
$110.22
|
|
|
Service Code
|
HCPCS 73040 26
|
| Min. Negotiated Rate |
$22.04 |
| Max. Negotiated Rate |
$424.30 |
| Rate for Payer: Cash Price |
$29.35
|
| Rate for Payer: Cash Price |
$29.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.92
|
| Rate for Payer: Healthfirst QHP |
$31.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$31.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$26.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$82.66
|
| Rate for Payer: SOMOS Essential |
$82.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.49
|
|
|
CHG RADEX SHOULDER ARTHROGRAPHY RS&I
|
Professional
|
$455.56
|
|
|
Service Code
|
HCPCS 73040 TC
|
| Min. Negotiated Rate |
$22.04 |
| Max. Negotiated Rate |
$424.30 |
| Rate for Payer: Cash Price |
$124.40
|
| Rate for Payer: Cash Price |
$124.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$117.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$117.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$123.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$130.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$123.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$97.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$123.65
|
| Rate for Payer: Healthfirst QHP |
$130.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$91.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$130.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$110.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$91.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$130.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$341.67
|
| Rate for Payer: SOMOS Essential |
$341.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.16
|
|
|
CHG RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS
|
Professional
|
$148.75
|
|
|
Service Code
|
HCPCS 73030
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$111.56 |
| Rate for Payer: Cash Price |
$40.93
|
| Rate for Payer: Cash Price |
$40.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$42.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$40.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40.38
|
| Rate for Payer: Healthfirst QHP |
$42.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$29.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$42.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$36.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$42.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$111.56
|
| Rate for Payer: SOMOS Essential |
$111.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.50
|
|
