|
CHG RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT
|
Professional
|
$45.75
|
|
|
Service Code
|
HCPCS 70330 26
|
| Min. Negotiated Rate |
$9.15 |
| Max. Negotiated Rate |
$170.05 |
| Rate for Payer: Cash Price |
$12.53
|
| Rate for Payer: Cash Price |
$12.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.42
|
| Rate for Payer: Healthfirst QHP |
$13.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$13.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$11.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$34.31
|
| Rate for Payer: SOMOS Essential |
$34.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.07
|
|
|
CHG RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT
|
Professional
|
$180.99
|
|
|
Service Code
|
HCPCS 70330 TC
|
| Min. Negotiated Rate |
$9.15 |
| Max. Negotiated Rate |
$170.05 |
| Rate for Payer: Cash Price |
$49.35
|
| Rate for Payer: Cash Price |
$49.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$46.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$46.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$51.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.12
|
| Rate for Payer: Healthfirst QHP |
$51.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$51.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$43.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$51.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$135.74
|
| Rate for Payer: SOMOS Essential |
$135.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$51.71
|
|
|
CHG RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT
|
Professional
|
$226.73
|
|
|
Service Code
|
HCPCS 70330
|
| Min. Negotiated Rate |
$9.15 |
| Max. Negotiated Rate |
$170.05 |
| Rate for Payer: Cash Price |
$61.88
|
| Rate for Payer: Cash Price |
$61.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$58.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$61.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$64.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$61.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$64.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$64.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$48.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.54
|
| Rate for Payer: Healthfirst QHP |
$64.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$64.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$55.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$64.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$170.05
|
| Rate for Payer: SOMOS Essential |
$170.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$64.78
|
|
|
CHG RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH UNILAT
|
Professional
|
$148.75
|
|
|
Service Code
|
HCPCS 70328
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$111.56 |
| Rate for Payer: Cash Price |
$40.53
|
| Rate for Payer: Cash Price |
$40.53
|
| 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
|
|
|
CHG RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH UNILAT
|
Professional
|
$35.35
|
|
|
Service Code
|
HCPCS 70328 26
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$111.56 |
| Rate for Payer: Cash Price |
$9.65
|
| Rate for Payer: Cash Price |
$9.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.60
|
| Rate for Payer: Healthfirst QHP |
$10.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$7.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$10.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.51
|
| Rate for Payer: SOMOS Essential |
$26.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.10
|
|
|
CHG RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH UNILAT
|
Professional
|
$113.44
|
|
|
Service Code
|
HCPCS 70328 TC
|
| Min. Negotiated Rate |
$7.07 |
| 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 |
$29.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30.79
|
| Rate for Payer: Healthfirst QHP |
$32.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$85.08
|
| Rate for Payer: SOMOS Essential |
$85.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.41
|
|
|
CHG RADEX TOE MINIMUM 2 VIEWS
|
Professional
|
$100.49
|
|
|
Service Code
|
HCPCS 73660 TC
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$95.02 |
| Rate for Payer: Cash Price |
$27.35
|
| Rate for Payer: Cash Price |
$27.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.27
|
| Rate for Payer: Healthfirst QHP |
$28.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$75.37
|
| Rate for Payer: SOMOS Essential |
$75.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.71
|
|
|
CHG RADEX TOE MINIMUM 2 VIEWS
|
Professional
|
$126.70
|
|
|
Service Code
|
HCPCS 73660
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$95.02 |
| Rate for Payer: Cash Price |
$34.47
|
| Rate for Payer: Cash Price |
$34.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.39
|
| Rate for Payer: Healthfirst QHP |
$36.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$36.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$95.02
|
| Rate for Payer: SOMOS Essential |
$95.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.20
|
|
|
CHG RADEX TOE MINIMUM 2 VIEWS
|
Professional
|
$26.22
|
|
|
Service Code
|
HCPCS 73660 26
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$95.02 |
| Rate for Payer: Cash Price |
$7.12
|
| Rate for Payer: Cash Price |
$7.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.12
|
| Rate for Payer: Healthfirst QHP |
$7.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$5.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$7.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$6.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$5.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19.66
|
| Rate for Payer: SOMOS Essential |
$19.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.49
|
|
|
CHG RADEX UPPER EXTREMITY INFANT MINIMUM 2 VIEWS
|
Professional
|
$104.79
|
|
|
Service Code
|
HCPCS 73092 TC
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$102.14 |
| Rate for Payer: Cash Price |
$28.52
|
| Rate for Payer: Cash Price |
$28.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$28.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.44
|
| Rate for Payer: Healthfirst QHP |
$29.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$25.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$78.59
|
| Rate for Payer: SOMOS Essential |
$78.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.94
|
|
|
CHG RADEX UPPER EXTREMITY INFANT MINIMUM 2 VIEWS
|
Professional
|
$136.19
|
|
|
Service Code
|
HCPCS 73092
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$102.14 |
| Rate for Payer: Cash Price |
$37.09
|
| Rate for Payer: Cash Price |
$37.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.96
|
| Rate for Payer: Healthfirst QHP |
$38.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$102.14
|
| Rate for Payer: SOMOS Essential |
$102.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.91
|
|
|
CHG RADEX UPPER EXTREMITY INFANT MINIMUM 2 VIEWS
|
Professional
|
$31.40
|
|
|
Service Code
|
HCPCS 73092 26
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$102.14 |
| Rate for Payer: Cash Price |
$8.56
|
| Rate for Payer: Cash Price |
$8.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.52
|
| Rate for Payer: Healthfirst QHP |
$8.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.55
|
| Rate for Payer: SOMOS Essential |
$23.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.97
|
|
|
CHG RADEX WRIST 2 VIEWS
|
Professional
|
$32.83
|
|
|
Service Code
|
HCPCS 73100 26
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$109.70 |
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.91
|
| Rate for Payer: Healthfirst QHP |
$9.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.62
|
| Rate for Payer: SOMOS Essential |
$24.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.38
|
|
|
CHG RADEX WRIST 2 VIEWS
|
Professional
|
$146.27
|
|
|
Service Code
|
HCPCS 73100
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$109.70 |
| Rate for Payer: Cash Price |
$39.84
|
| Rate for Payer: Cash Price |
$39.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$39.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$39.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.70
|
| Rate for Payer: Healthfirst QHP |
$41.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$29.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$41.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$35.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$109.70
|
| Rate for Payer: SOMOS Essential |
$109.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.79
|
|
|
CHG RADEX WRIST 2 VIEWS
|
Professional
|
$113.44
|
|
|
Service Code
|
HCPCS 73100 TC
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$109.70 |
| Rate for Payer: Cash Price |
$30.88
|
| Rate for Payer: Cash Price |
$30.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30.79
|
| Rate for Payer: Healthfirst QHP |
$32.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$85.08
|
| Rate for Payer: SOMOS Essential |
$85.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.41
|
|
|
CHG RADEX WRIST ARTHROGRAPHY RS&I
|
Professional
|
$471.35
|
|
|
Service Code
|
HCPCS 73115 TC
|
| Min. Negotiated Rate |
$22.33 |
| Max. Negotiated Rate |
$437.25 |
| Rate for Payer: Cash Price |
$127.94
|
| Rate for Payer: Cash Price |
$127.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$121.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$121.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$127.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$134.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$127.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$134.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$134.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$101.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$127.94
|
| Rate for Payer: Healthfirst QHP |
$134.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$94.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$134.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$114.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$94.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$134.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$353.51
|
| Rate for Payer: SOMOS Essential |
$353.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$134.67
|
|
|
CHG RADEX WRIST ARTHROGRAPHY RS&I
|
Professional
|
$111.65
|
|
|
Service Code
|
HCPCS 73115 26
|
| Min. Negotiated Rate |
$22.33 |
| Max. Negotiated Rate |
$437.25 |
| Rate for Payer: Cash Price |
$29.75
|
| Rate for Payer: Cash Price |
$29.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30.30
|
| Rate for Payer: Healthfirst QHP |
$31.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$31.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$83.74
|
| Rate for Payer: SOMOS Essential |
$83.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.90
|
|
|
CHG RADEX WRIST ARTHROGRAPHY RS&I
|
Professional
|
$583.00
|
|
|
Service Code
|
HCPCS 73115
|
| Min. Negotiated Rate |
$22.33 |
| Max. Negotiated Rate |
$437.25 |
| Rate for Payer: Cash Price |
$157.68
|
| Rate for Payer: Cash Price |
$157.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$149.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$149.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$158.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$166.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$158.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$166.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$166.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$124.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$158.24
|
| Rate for Payer: Healthfirst QHP |
$166.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$116.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$166.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$141.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$116.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$166.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$437.25
|
| Rate for Payer: SOMOS Essential |
$437.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$166.57
|
|
|
CHG RADEX WRIST COMPLETE MINIMUM 3 VIEWS
|
Professional
|
$142.17
|
|
|
Service Code
|
HCPCS 73110 TC
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$132.20 |
| 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 WRIST COMPLETE MINIMUM 3 VIEWS
|
Professional
|
$34.09
|
|
|
Service Code
|
HCPCS 73110 26
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$132.20 |
| 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 WRIST COMPLETE MINIMUM 3 VIEWS
|
Professional
|
$176.26
|
|
|
Service Code
|
HCPCS 73110
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$132.20 |
| Rate for Payer: Cash Price |
$48.44
|
| Rate for Payer: Cash Price |
$48.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$45.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$45.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$47.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$50.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$47.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$37.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.84
|
| Rate for Payer: Healthfirst QHP |
$50.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$35.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$50.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$42.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$35.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$50.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$132.20
|
| Rate for Payer: SOMOS Essential |
$132.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50.36
|
|
|
CHG RADIATION DELIVERY STEREOTACTIC CRANIAL COBALT
|
Professional
|
$4,834.10
|
|
|
Service Code
|
HCPCS 77371
|
| Min. Negotiated Rate |
$3,625.58 |
| Max. Negotiated Rate |
$3,625.58 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,625.58
|
| Rate for Payer: SOMOS Essential |
$3,625.58
|
|
|
CHG RADIATION DELIVERY STEREOTACTIC CRANIAL LINEAR
|
Professional
|
$4,184.78
|
|
|
Service Code
|
HCPCS 77372
|
| Min. Negotiated Rate |
$836.96 |
| Max. Negotiated Rate |
$3,138.58 |
| Rate for Payer: Cash Price |
$1,128.04
|
| Rate for Payer: Cash Price |
$1,128.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,076.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,076.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,135.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,195.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,135.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,195.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,195.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$896.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,135.87
|
| Rate for Payer: Healthfirst QHP |
$1,195.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$836.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,195.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,016.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$836.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,195.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,138.58
|
| Rate for Payer: SOMOS Essential |
$3,138.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,195.65
|
|
|
CHG RADIATION THERAPY MGMT 1/2 FRACTIONS ONLY
|
Professional
|
$443.24
|
|
|
Service Code
|
HCPCS 77431
|
| Min. Negotiated Rate |
$88.65 |
| Max. Negotiated Rate |
$332.43 |
| Rate for Payer: Cash Price |
$122.01
|
| Rate for Payer: Cash Price |
$122.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$113.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$113.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$120.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$126.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$120.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$94.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$120.31
|
| Rate for Payer: Healthfirst QHP |
$126.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$88.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$126.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$107.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$88.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$126.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$332.43
|
| Rate for Payer: SOMOS Essential |
$332.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$126.64
|
|
|
CHG RADIATION TREATMENT MANAGEMENT 5 TREATMENTS
|
Professional
|
$789.36
|
|
|
Service Code
|
HCPCS 77427
|
| Min. Negotiated Rate |
$157.87 |
| Max. Negotiated Rate |
$592.02 |
| Rate for Payer: Cash Price |
$215.13
|
| Rate for Payer: Cash Price |
$215.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$202.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$202.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$214.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$225.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$214.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$225.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$169.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$214.25
|
| Rate for Payer: Healthfirst QHP |
$225.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$157.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$225.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$191.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$157.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$225.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$592.02
|
| Rate for Payer: SOMOS Essential |
$592.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$225.53
|
|
