|
CHG RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS
|
Professional
|
$36.79
|
|
|
Service Code
|
HCPCS 73030 26
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$111.56 |
| 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 SHOULDER COMPLETE MINIMUM 2 VIEWS
|
Professional
|
$112.00
|
|
|
Service Code
|
HCPCS 73030 TC
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$111.56 |
| Rate for Payer: Cash Price |
$30.88
|
| Rate for Payer: Cash Price |
$30.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30.40
|
| Rate for Payer: Healthfirst QHP |
$32.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$84.00
|
| Rate for Payer: SOMOS Essential |
$84.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.00
|
|
|
CHG RADEX SINUSES PARANASAL <3 VIEWS
|
Professional
|
$34.09
|
|
|
Service Code
|
HCPCS 70210 26
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$104.16 |
| 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 SINUSES PARANASAL <3 VIEWS
|
Professional
|
$138.88
|
|
|
Service Code
|
HCPCS 70210
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$104.16 |
| Rate for Payer: Cash Price |
$37.83
|
| Rate for Payer: Cash Price |
$37.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$39.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.70
|
| Rate for Payer: Healthfirst QHP |
$39.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$39.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$104.16
|
| Rate for Payer: SOMOS Essential |
$104.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.68
|
|
|
CHG RADEX SINUSES PARANASAL <3 VIEWS
|
Professional
|
$104.79
|
|
|
Service Code
|
HCPCS 70210 TC
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$104.16 |
| 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 SINUSES PARANASAL COMPL MINIMUM 3 VIEWS
|
Professional
|
$119.18
|
|
|
Service Code
|
HCPCS 70220 TC
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$120.73 |
| Rate for Payer: Cash Price |
$32.45
|
| Rate for Payer: Cash Price |
$32.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.35
|
| Rate for Payer: Healthfirst QHP |
$34.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$34.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$89.38
|
| Rate for Payer: SOMOS Essential |
$89.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.05
|
|
|
CHG RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS
|
Professional
|
$41.79
|
|
|
Service Code
|
HCPCS 70220 26
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$120.73 |
| Rate for Payer: Cash Price |
$11.44
|
| Rate for Payer: Cash Price |
$11.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.34
|
| Rate for Payer: Healthfirst QHP |
$11.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$11.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$10.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31.34
|
| Rate for Payer: SOMOS Essential |
$31.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.94
|
|
|
CHG RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS
|
Professional
|
$160.97
|
|
|
Service Code
|
HCPCS 70220
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$120.73 |
| Rate for Payer: Cash Price |
$43.89
|
| Rate for Payer: Cash Price |
$43.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$41.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$43.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$45.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43.69
|
| Rate for Payer: Healthfirst QHP |
$45.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$45.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$39.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$45.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$120.73
|
| Rate for Payer: SOMOS Essential |
$120.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.99
|
|
|
CHG RADEX SPINE 1 VIEW SPECIFY LEVEL
|
Professional
|
$31.40
|
|
|
Service Code
|
HCPCS 72020 26
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$79.52 |
| 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 SPINE 1 VIEW SPECIFY LEVEL
|
Professional
|
$74.62
|
|
|
Service Code
|
HCPCS 72020 TC
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$79.52 |
| Rate for Payer: Cash Price |
$19.88
|
| Rate for Payer: Cash Price |
$19.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$19.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$20.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20.25
|
| Rate for Payer: Healthfirst QHP |
$21.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$21.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$18.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$14.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$55.96
|
| Rate for Payer: SOMOS Essential |
$55.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.32
|
|
|
CHG RADEX SPINE 1 VIEW SPECIFY LEVEL
|
Professional
|
$106.02
|
|
|
Service Code
|
HCPCS 72020
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$79.52 |
| Rate for Payer: Cash Price |
$28.44
|
| Rate for Payer: Cash Price |
$28.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$27.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$28.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$30.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.78
|
| Rate for Payer: Healthfirst QHP |
$30.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$30.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$25.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$79.52
|
| Rate for Payer: SOMOS Essential |
$79.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30.29
|
|
|
CHG RADEX SPINE CERVICAL 2 OR 3 VIEWS
|
Professional
|
$169.58
|
|
|
Service Code
|
HCPCS 72040
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$127.18 |
| Rate for Payer: Cash Price |
$46.25
|
| Rate for Payer: Cash Price |
$46.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$46.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$48.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$46.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.03
|
| Rate for Payer: Healthfirst QHP |
$48.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$33.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$48.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$41.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$33.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$48.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$127.18
|
| Rate for Payer: SOMOS Essential |
$127.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$48.45
|
|
|
CHG RADEX SPINE CERVICAL 2 OR 3 VIEWS
|
Professional
|
$43.23
|
|
|
Service Code
|
HCPCS 72040 26
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$127.18 |
| 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 SPINE CERVICAL 2 OR 3 VIEWS
|
Professional
|
$126.35
|
|
|
Service Code
|
HCPCS 72040 TC
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$127.18 |
| Rate for Payer: Cash Price |
$34.42
|
| Rate for Payer: Cash Price |
$34.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.30
|
| Rate for Payer: Healthfirst QHP |
$36.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$36.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$94.76
|
| Rate for Payer: SOMOS Essential |
$94.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.10
|
|
|
CHG RADEX SPINE CERVICAL 4 OR 5 VIEWS
|
Professional
|
$227.61
|
|
|
Service Code
|
HCPCS 72050
|
| Min. Negotiated Rate |
$10.47 |
| Max. Negotiated Rate |
$170.71 |
| Rate for Payer: Cash Price |
$62.53
|
| Rate for Payer: Cash Price |
$62.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$58.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$61.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$65.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$61.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$48.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.78
|
| Rate for Payer: Healthfirst QHP |
$65.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$65.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$55.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$65.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$170.71
|
| Rate for Payer: SOMOS Essential |
$170.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.03
|
|
|
CHG RADEX SPINE CERVICAL 4 OR 5 VIEWS
|
Professional
|
$175.25
|
|
|
Service Code
|
HCPCS 72050 TC
|
| Min. Negotiated Rate |
$10.47 |
| Max. Negotiated Rate |
$170.71 |
| Rate for Payer: Cash Price |
$48.56
|
| Rate for Payer: Cash Price |
$48.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$45.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$45.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$47.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$50.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$47.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$37.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.57
|
| Rate for Payer: Healthfirst QHP |
$50.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$35.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$50.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$42.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$35.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$50.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$131.44
|
| Rate for Payer: SOMOS Essential |
$131.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50.07
|
|
|
CHG RADEX SPINE CERVICAL 4 OR 5 VIEWS
|
Professional
|
$52.36
|
|
|
Service Code
|
HCPCS 72050 26
|
| Min. Negotiated Rate |
$10.47 |
| Max. Negotiated Rate |
$170.71 |
| Rate for Payer: Cash Price |
$13.97
|
| Rate for Payer: Cash Price |
$13.97
|
| 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 SPINE CERVICAL 6 OR MORE VIEWS
|
Professional
|
$267.16
|
|
|
Service Code
|
HCPCS 72052
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$200.37 |
| Rate for Payer: Cash Price |
$73.24
|
| Rate for Payer: Cash Price |
$73.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$68.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$68.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$72.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$76.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$72.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$76.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$72.51
|
| Rate for Payer: Healthfirst QHP |
$76.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$53.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$76.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$64.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$53.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$76.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$200.37
|
| Rate for Payer: SOMOS Essential |
$200.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$76.33
|
|
|
CHG RADEX SPINE CERVICAL 6 OR MORE VIEWS
|
Professional
|
$58.87
|
|
|
Service Code
|
HCPCS 72052 26
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$200.37 |
| Rate for Payer: Cash Price |
$16.04
|
| Rate for Payer: Cash Price |
$16.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.98
|
| Rate for Payer: Healthfirst QHP |
$16.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$16.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$14.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$44.15
|
| Rate for Payer: SOMOS Essential |
$44.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.82
|
|
|
CHG RADEX SPINE CERVICAL 6 OR MORE VIEWS
|
Professional
|
$208.29
|
|
|
Service Code
|
HCPCS 72052 TC
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$200.37 |
| Rate for Payer: Cash Price |
$57.21
|
| Rate for Payer: Cash Price |
$57.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$53.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$56.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$59.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$56.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$59.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$56.53
|
| Rate for Payer: Healthfirst QHP |
$59.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$41.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$59.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$50.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$41.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$59.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$156.22
|
| Rate for Payer: SOMOS Essential |
$156.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$59.51
|
|
|
CHG RADEX SPINE LUMBOSACRAL 2/3 VIEWS
|
Professional
|
$43.23
|
|
|
Service Code
|
HCPCS 72100 26
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$128.26 |
| 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 SPINE LUMBOSACRAL 2/3 VIEWS
|
Professional
|
$171.01
|
|
|
Service Code
|
HCPCS 72100
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$128.26 |
| Rate for Payer: Cash Price |
$46.64
|
| Rate for Payer: Cash Price |
$46.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$46.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$48.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$46.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.42
|
| Rate for Payer: Healthfirst QHP |
$48.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$48.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$41.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$48.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$128.26
|
| Rate for Payer: SOMOS Essential |
$128.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$48.86
|
|
|
CHG RADEX SPINE LUMBOSACRAL 2/3 VIEWS
|
Professional
|
$127.79
|
|
|
Service Code
|
HCPCS 72100 TC
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$128.26 |
| Rate for Payer: Cash Price |
$34.81
|
| Rate for Payer: Cash Price |
$34.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.68
|
| Rate for Payer: Healthfirst QHP |
$36.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$36.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$31.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$95.84
|
| Rate for Payer: SOMOS Essential |
$95.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.51
|
|
|
CHG RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS
|
Professional
|
$49.67
|
|
|
Service Code
|
HCPCS 72110 26
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$164.38 |
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.48
|
| Rate for Payer: Healthfirst QHP |
$14.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$14.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$12.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$37.25
|
| Rate for Payer: SOMOS Essential |
$37.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.19
|
|
|
CHG RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS
|
Professional
|
$169.47
|
|
|
Service Code
|
HCPCS 72110 TC
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$164.38 |
| Rate for Payer: Cash Price |
$46.99
|
| Rate for Payer: Cash Price |
$46.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$46.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$48.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$46.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.00
|
| Rate for Payer: Healthfirst QHP |
$48.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$33.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$48.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$41.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$33.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$48.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$127.10
|
| Rate for Payer: SOMOS Essential |
$127.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$48.42
|
|
