|
CHG RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS
|
Professional
|
$219.17
|
|
|
Service Code
|
HCPCS 72110
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$164.38 |
| Rate for Payer: Cash Price |
$60.61
|
| Rate for Payer: Cash Price |
$60.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$56.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$56.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$59.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$59.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$62.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$46.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$59.49
|
| Rate for Payer: Healthfirst QHP |
$62.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$43.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$62.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$53.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$43.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$164.38
|
| Rate for Payer: SOMOS Essential |
$164.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.62
|
|
|
CHG RADEX SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS
|
Professional
|
$173.92
|
|
|
Service Code
|
HCPCS 72120
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$130.44 |
| Rate for Payer: Cash Price |
$47.43
|
| Rate for Payer: Cash Price |
$47.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$44.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$44.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$47.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$49.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$47.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$37.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.21
|
| Rate for Payer: Healthfirst QHP |
$49.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$49.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$42.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$49.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$130.44
|
| Rate for Payer: SOMOS Essential |
$130.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$49.69
|
|
|
CHG RADEX SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS
|
Professional
|
$130.69
|
|
|
Service Code
|
HCPCS 72120 TC
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$130.44 |
| Rate for Payer: Cash Price |
$35.60
|
| Rate for Payer: Cash Price |
$35.60
|
| 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 SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS
|
Professional
|
$43.23
|
|
|
Service Code
|
HCPCS 72120 26
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$130.44 |
| 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 LUMBSCRL COMPL W/BENDING VIEWS MIN 6
|
Professional
|
$265.72
|
|
|
Service Code
|
HCPCS 72114
|
| Min. Negotiated Rate |
$12.06 |
| Max. Negotiated Rate |
$199.29 |
| Rate for Payer: Cash Price |
$71.67
|
| Rate for Payer: Cash Price |
$71.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$68.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$68.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$72.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$75.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$72.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$56.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$72.12
|
| Rate for Payer: Healthfirst QHP |
$75.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$53.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$75.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$64.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$53.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$75.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$199.29
|
| Rate for Payer: SOMOS Essential |
$199.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$75.92
|
|
|
CHG RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6
|
Professional
|
$205.42
|
|
|
Service Code
|
HCPCS 72114 TC
|
| Min. Negotiated Rate |
$12.06 |
| Max. Negotiated Rate |
$199.29 |
| Rate for Payer: Cash Price |
$55.64
|
| Rate for Payer: Cash Price |
$55.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$52.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$52.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$55.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$58.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$55.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$58.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$58.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$55.76
|
| Rate for Payer: Healthfirst QHP |
$58.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$41.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$58.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$49.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$41.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$58.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$154.06
|
| Rate for Payer: SOMOS Essential |
$154.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$58.69
|
|
|
CHG RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6
|
Professional
|
$60.31
|
|
|
Service Code
|
HCPCS 72114 26
|
| Min. Negotiated Rate |
$12.06 |
| Max. Negotiated Rate |
$199.29 |
| Rate for Payer: Cash Price |
$16.04
|
| Rate for Payer: Cash Price |
$16.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.37
|
| Rate for Payer: Healthfirst QHP |
$17.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$12.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$17.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$14.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$12.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$45.23
|
| Rate for Payer: SOMOS Essential |
$45.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.23
|
|
|
CHG RADEX SPINE THORACIC 2 VIEWS
|
Professional
|
$39.27
|
|
|
Service Code
|
HCPCS 72070 26
|
| Min. Negotiated Rate |
$7.85 |
| Max. Negotiated Rate |
$105.92 |
| Rate for Payer: Cash Price |
$10.74
|
| Rate for Payer: Cash Price |
$10.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.66
|
| Rate for Payer: Healthfirst QHP |
$11.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$7.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$11.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$9.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.45
|
| Rate for Payer: SOMOS Essential |
$29.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.22
|
|
|
CHG RADEX SPINE THORACIC 2 VIEWS
|
Professional
|
$101.92
|
|
|
Service Code
|
HCPCS 72070 TC
|
| Min. Negotiated Rate |
$7.85 |
| Max. Negotiated Rate |
$105.92 |
| Rate for Payer: Cash Price |
$27.74
|
| Rate for Payer: Cash Price |
$27.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.66
|
| Rate for Payer: Healthfirst QHP |
$29.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$76.44
|
| Rate for Payer: SOMOS Essential |
$76.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.12
|
|
|
CHG RADEX SPINE THORACIC 2 VIEWS
|
Professional
|
$141.23
|
|
|
Service Code
|
HCPCS 72070
|
| Min. Negotiated Rate |
$7.85 |
| Max. Negotiated Rate |
$105.92 |
| Rate for Payer: Cash Price |
$38.48
|
| Rate for Payer: Cash Price |
$38.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.33
|
| Rate for Payer: Healthfirst QHP |
$40.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$40.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$105.92
|
| Rate for Payer: SOMOS Essential |
$105.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.35
|
|
|
CHG RADEX SPINE THORACIC 3 VIEWS
|
Professional
|
$124.92
|
|
|
Service Code
|
HCPCS 72072 TC
|
| Min. Negotiated Rate |
$8.61 |
| Max. Negotiated Rate |
$125.98 |
| Rate for Payer: Cash Price |
$34.42
|
| Rate for Payer: Cash Price |
$34.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.91
|
| Rate for Payer: Healthfirst QHP |
$35.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$35.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$93.69
|
| Rate for Payer: SOMOS Essential |
$93.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.69
|
|
|
CHG RADEX SPINE THORACIC 3 VIEWS
|
Professional
|
$167.97
|
|
|
Service Code
|
HCPCS 72072
|
| Min. Negotiated Rate |
$8.61 |
| Max. Negotiated Rate |
$125.98 |
| Rate for Payer: Cash Price |
$46.21
|
| Rate for Payer: Cash Price |
$46.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$45.59
|
| Rate for Payer: Healthfirst QHP |
$47.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$33.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$47.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$40.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$33.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$125.98
|
| Rate for Payer: SOMOS Essential |
$125.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.99
|
|
|
CHG RADEX SPINE THORACIC 3 VIEWS
|
Professional
|
$43.05
|
|
|
Service Code
|
HCPCS 72072 26
|
| Min. Negotiated Rate |
$8.61 |
| Max. Negotiated Rate |
$125.98 |
| Rate for Payer: Cash Price |
$11.79
|
| Rate for Payer: Cash Price |
$11.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.68
|
| Rate for Payer: Healthfirst QHP |
$12.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$12.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$10.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.29
|
| Rate for Payer: SOMOS Essential |
$32.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.30
|
|
|
CHG RADEX SPINE THORACIC MINIMUM 4 VIEWS
|
Professional
|
$46.97
|
|
|
Service Code
|
HCPCS 72074 26
|
| Min. Negotiated Rate |
$9.39 |
| Max. Negotiated Rate |
$141.88 |
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.75
|
| Rate for Payer: Healthfirst QHP |
$13.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$13.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$11.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35.23
|
| Rate for Payer: SOMOS Essential |
$35.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.42
|
|
|
CHG RADEX SPINE THORACIC MINIMUM 4 VIEWS
|
Professional
|
$189.18
|
|
|
Service Code
|
HCPCS 72074
|
| Min. Negotiated Rate |
$9.39 |
| Max. Negotiated Rate |
$141.88 |
| Rate for Payer: Cash Price |
$52.01
|
| Rate for Payer: Cash Price |
$52.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$48.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$48.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$51.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$54.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$51.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$51.35
|
| Rate for Payer: Healthfirst QHP |
$54.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$54.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$45.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$54.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$141.88
|
| Rate for Payer: SOMOS Essential |
$141.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.05
|
|
|
CHG RADEX SPINE THORACIC MINIMUM 4 VIEWS
|
Professional
|
$142.17
|
|
|
Service Code
|
HCPCS 72074 TC
|
| Min. Negotiated Rate |
$9.39 |
| Max. Negotiated Rate |
$141.88 |
| Rate for Payer: Cash Price |
$39.13
|
| Rate for Payer: Cash Price |
$39.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.59
|
| Rate for Payer: Healthfirst QHP |
$40.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$40.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$106.63
|
| Rate for Payer: SOMOS Essential |
$106.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.62
|
|
|
CHG RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS
|
Professional
|
$40.53
|
|
|
Service Code
|
HCPCS 72080 26
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$111.17 |
| Rate for Payer: Cash Price |
$11.09
|
| Rate for Payer: Cash Price |
$11.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.00
|
| Rate for Payer: Healthfirst QHP |
$11.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$11.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$9.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$30.40
|
| Rate for Payer: SOMOS Essential |
$30.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.58
|
|
|
CHG RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS
|
Professional
|
$148.23
|
|
|
Service Code
|
HCPCS 72080
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$111.17 |
| Rate for Payer: Cash Price |
$40.40
|
| Rate for Payer: Cash Price |
$40.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$42.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$40.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40.23
|
| Rate for Payer: Healthfirst QHP |
$42.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$29.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$42.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$36.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$42.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$111.17
|
| Rate for Payer: SOMOS Essential |
$111.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.35
|
|
|
CHG RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS
|
Professional
|
$107.66
|
|
|
Service Code
|
HCPCS 72080 TC
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$111.17 |
| Rate for Payer: Cash Price |
$29.31
|
| Rate for Payer: Cash Price |
$29.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$27.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$30.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.22
|
| Rate for Payer: Healthfirst QHP |
$30.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$30.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$26.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$80.74
|
| Rate for Payer: SOMOS Essential |
$80.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30.76
|
|
|
CHG RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS
|
Professional
|
$135.00
|
|
|
Service Code
|
HCPCS 71130 TC
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$132.59 |
| Rate for Payer: Cash Price |
$36.78
|
| Rate for Payer: Cash Price |
$36.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.64
|
| Rate for Payer: Healthfirst QHP |
$38.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$101.25
|
| Rate for Payer: SOMOS Essential |
$101.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.57
|
|
|
CHG RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS
|
Professional
|
$41.79
|
|
|
Service Code
|
HCPCS 71130 26
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$132.59 |
| 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 STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS
|
Professional
|
$176.79
|
|
|
Service Code
|
HCPCS 71130
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$132.59 |
| Rate for Payer: Cash Price |
$48.22
|
| Rate for Payer: Cash Price |
$48.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$45.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$45.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$47.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$50.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$47.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$37.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.98
|
| Rate for Payer: Healthfirst QHP |
$50.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$35.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$50.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$42.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$35.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$50.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$132.59
|
| Rate for Payer: SOMOS Essential |
$132.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50.51
|
|
|
CHG RADEX STERNUM MINIMUM 2 VIEWS
|
Professional
|
$106.23
|
|
|
Service Code
|
HCPCS 71120 TC
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$108.08 |
| 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 STERNUM MINIMUM 2 VIEWS
|
Professional
|
$37.84
|
|
|
Service Code
|
HCPCS 71120 26
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$108.08 |
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.27
|
| Rate for Payer: Healthfirst QHP |
$10.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$7.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$10.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$9.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.38
|
| Rate for Payer: SOMOS Essential |
$28.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.81
|
|
|
CHG RADEX STERNUM MINIMUM 2 VIEWS
|
Professional
|
$144.10
|
|
|
Service Code
|
HCPCS 71120
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$108.08 |
| Rate for Payer: Cash Price |
$39.27
|
| Rate for Payer: Cash Price |
$39.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$39.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$39.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.11
|
| Rate for Payer: Healthfirst QHP |
$41.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$41.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$108.08
|
| Rate for Payer: SOMOS Essential |
$108.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.17
|
|
