|
CHG RADIATION TX DELIVERY SUPERFICIAL&/ORTHO VOLTA
|
Professional
|
$178.12
|
|
|
Service Code
|
HCPCS 77401
|
| Min. Negotiated Rate |
$35.62 |
| Max. Negotiated Rate |
$133.59 |
| Rate for Payer: Cash Price |
$49.35
|
| Rate for Payer: Cash Price |
$49.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$45.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$45.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$48.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$50.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$48.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$48.35
|
| Rate for Payer: Healthfirst QHP |
$50.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$35.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$50.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$43.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$35.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$50.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$133.59
|
| Rate for Payer: SOMOS Essential |
$133.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50.89
|
|
|
CHG RADIOLOG EXAM MANDIBLE COMPL MINIMUM 4 VIEWS
|
Professional
|
$46.97
|
|
|
Service Code
|
HCPCS 70110 26
|
| Min. Negotiated Rate |
$9.39 |
| Max. Negotiated Rate |
$138.63 |
| 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 RADIOLOG EXAM MANDIBLE COMPL MINIMUM 4 VIEWS
|
Professional
|
$137.87
|
|
|
Service Code
|
HCPCS 70110 TC
|
| Min. Negotiated Rate |
$9.39 |
| Max. Negotiated Rate |
$138.63 |
| Rate for Payer: Cash Price |
$37.95
|
| Rate for Payer: Cash Price |
$37.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$39.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.42
|
| Rate for Payer: Healthfirst QHP |
$39.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$39.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$103.40
|
| Rate for Payer: SOMOS Essential |
$103.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.39
|
|
|
CHG RADIOLOG EXAM MANDIBLE COMPL MINIMUM 4 VIEWS
|
Professional
|
$184.84
|
|
|
Service Code
|
HCPCS 70110
|
| Min. Negotiated Rate |
$9.39 |
| Max. Negotiated Rate |
$138.63 |
| Rate for Payer: Cash Price |
$50.83
|
| Rate for Payer: Cash Price |
$50.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$50.17
|
| Rate for Payer: Healthfirst QHP |
$52.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$138.63
|
| Rate for Payer: SOMOS Essential |
$138.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.81
|
|
|
CHG RADIOLOGICAL EXAMINATION SURGICAL SPECIMEN
|
Professional
|
$117.74
|
|
|
Service Code
|
HCPCS 76098 TC
|
| Min. Negotiated Rate |
$12.31 |
| Max. Negotiated Rate |
$134.45 |
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.96
|
| Rate for Payer: Healthfirst QHP |
$33.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$33.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$88.30
|
| Rate for Payer: SOMOS Essential |
$88.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.64
|
|
|
CHG RADIOLOGICAL EXAMINATION SURGICAL SPECIMEN
|
Professional
|
$179.27
|
|
|
Service Code
|
HCPCS 76098
|
| Min. Negotiated Rate |
$12.31 |
| Max. Negotiated Rate |
$134.45 |
| Rate for Payer: Cash Price |
$49.62
|
| Rate for Payer: Cash Price |
$49.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$46.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$46.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$48.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$51.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$48.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$48.66
|
| Rate for Payer: Healthfirst QHP |
$51.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$35.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$51.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$43.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$35.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$51.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$134.45
|
| Rate for Payer: SOMOS Essential |
$134.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$51.22
|
|
|
CHG RADIOLOGICAL EXAMINATION SURGICAL SPECIMEN
|
Professional
|
$61.57
|
|
|
Service Code
|
HCPCS 76098 26
|
| Min. Negotiated Rate |
$12.31 |
| Max. Negotiated Rate |
$134.45 |
| Rate for Payer: Cash Price |
$16.78
|
| Rate for Payer: Cash Price |
$16.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.71
|
| Rate for Payer: Healthfirst QHP |
$17.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$12.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$17.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$14.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$12.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$46.18
|
| Rate for Payer: SOMOS Essential |
$46.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.59
|
|
|
CHG RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I
|
Professional
|
$251.44
|
|
|
Service Code
|
HCPCS 75989 TC
|
| Min. Negotiated Rate |
$44.82 |
| Max. Negotiated Rate |
$356.66 |
| Rate for Payer: Cash Price |
$67.42
|
| Rate for Payer: Cash Price |
$67.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$64.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$64.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$68.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$71.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$68.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$71.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$71.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$53.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$68.25
|
| Rate for Payer: Healthfirst QHP |
$71.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$50.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$71.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$61.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$50.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$71.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$188.58
|
| Rate for Payer: SOMOS Essential |
$188.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$71.84
|
|
|
CHG RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I
|
Professional
|
$475.55
|
|
|
Service Code
|
HCPCS 75989
|
| Min. Negotiated Rate |
$44.82 |
| Max. Negotiated Rate |
$356.66 |
| Rate for Payer: Cash Price |
$128.07
|
| Rate for Payer: Cash Price |
$128.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$122.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$122.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$129.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$135.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$129.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$135.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$135.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$101.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$129.08
|
| Rate for Payer: Healthfirst QHP |
$135.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$95.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$135.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$115.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$95.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$135.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$356.66
|
| Rate for Payer: SOMOS Essential |
$356.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$135.87
|
|
|
CHG RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I
|
Professional
|
$224.11
|
|
|
Service Code
|
HCPCS 75989 26
|
| Min. Negotiated Rate |
$44.82 |
| Max. Negotiated Rate |
$356.66 |
| Rate for Payer: Cash Price |
$60.65
|
| Rate for Payer: Cash Price |
$60.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$57.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$57.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$60.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$64.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$60.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$64.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$64.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$48.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.83
|
| Rate for Payer: Healthfirst QHP |
$64.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$44.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$64.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$54.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$44.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$64.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$168.08
|
| Rate for Payer: SOMOS Essential |
$168.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$64.03
|
|
|
CHG RADIOLOGIC EXAM ABDOMEN 1 VIEW
|
Professional
|
$93.31
|
|
|
Service Code
|
HCPCS 74018 TC
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$96.47 |
| Rate for Payer: Cash Price |
$25.77
|
| Rate for Payer: Cash Price |
$25.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.33
|
| Rate for Payer: Healthfirst QHP |
$26.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$26.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.98
|
| Rate for Payer: SOMOS Essential |
$69.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.66
|
|
|
CHG RADIOLOGIC EXAM ABDOMEN 1 VIEW
|
Professional
|
$128.63
|
|
|
Service Code
|
HCPCS 74018
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$96.47 |
| Rate for Payer: Cash Price |
$35.43
|
| Rate for Payer: Cash Price |
$35.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.91
|
| Rate for Payer: Healthfirst QHP |
$36.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$36.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$31.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$96.47
|
| Rate for Payer: SOMOS Essential |
$96.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.75
|
|
|
CHG RADIOLOGIC EXAM ABDOMEN 1 VIEW
|
Professional
|
$35.35
|
|
|
Service Code
|
HCPCS 74018 26
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$96.47 |
| 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 RADIOLOGIC EXAM ABDOMEN 2 VIEWS
|
Professional
|
$157.92
|
|
|
Service Code
|
HCPCS 74019
|
| Min. Negotiated Rate |
$8.90 |
| Max. Negotiated Rate |
$118.44 |
| Rate for Payer: Cash Price |
$42.67
|
| Rate for Payer: Cash Price |
$42.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$42.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$45.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$42.86
|
| Rate for Payer: Healthfirst QHP |
$45.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$45.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$38.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$45.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$118.44
|
| Rate for Payer: SOMOS Essential |
$118.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.12
|
|
|
CHG RADIOLOGIC EXAM ABDOMEN 2 VIEWS
|
Professional
|
$113.44
|
|
|
Service Code
|
HCPCS 74019 TC
|
| Min. Negotiated Rate |
$8.90 |
| Max. Negotiated Rate |
$118.44 |
| 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 RADIOLOGIC EXAM ABDOMEN 2 VIEWS
|
Professional
|
$44.49
|
|
|
Service Code
|
HCPCS 74019 26
|
| Min. Negotiated Rate |
$8.90 |
| Max. Negotiated Rate |
$118.44 |
| Rate for Payer: Cash Price |
$11.79
|
| Rate for Payer: Cash Price |
$11.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.07
|
| Rate for Payer: Healthfirst QHP |
$12.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$12.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$10.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$33.37
|
| Rate for Payer: SOMOS Essential |
$33.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.71
|
|
|
CHG RADIOLOGIC EXAM ABDOMEN 3+ VIEWS
|
Professional
|
$132.13
|
|
|
Service Code
|
HCPCS 74021 TC
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$137.29 |
| Rate for Payer: Cash Price |
$35.99
|
| Rate for Payer: Cash Price |
$35.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.86
|
| Rate for Payer: Healthfirst QHP |
$37.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$37.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$99.10
|
| Rate for Payer: SOMOS Essential |
$99.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.75
|
|
|
CHG RADIOLOGIC EXAM ABDOMEN 3+ VIEWS
|
Professional
|
$183.05
|
|
|
Service Code
|
HCPCS 74021
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$137.29 |
| Rate for Payer: Cash Price |
$49.96
|
| Rate for Payer: Cash Price |
$49.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.68
|
| Rate for Payer: Healthfirst QHP |
$52.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$137.29
|
| Rate for Payer: SOMOS Essential |
$137.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.30
|
|
|
CHG RADIOLOGIC EXAM ABDOMEN 3+ VIEWS
|
Professional
|
$50.93
|
|
|
Service Code
|
HCPCS 74021 26
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$137.29 |
| Rate for Payer: Cash Price |
$13.97
|
| Rate for Payer: Cash Price |
$13.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.82
|
| Rate for Payer: Healthfirst QHP |
$14.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$10.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$14.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$12.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$10.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$38.20
|
| Rate for Payer: SOMOS Essential |
$38.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.55
|
|
|
CHG RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST
|
Professional
|
$34.27
|
|
|
Service Code
|
HCPCS 73565 26
|
| Min. Negotiated Rate |
$6.85 |
| Max. Negotiated Rate |
$129.10 |
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.30
|
| Rate for Payer: Healthfirst QHP |
$9.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.70
|
| Rate for Payer: SOMOS Essential |
$25.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.79
|
|
|
CHG RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST
|
Professional
|
$172.13
|
|
|
Service Code
|
HCPCS 73565
|
| Min. Negotiated Rate |
$6.85 |
| Max. Negotiated Rate |
$129.10 |
| Rate for Payer: Cash Price |
$46.91
|
| Rate for Payer: Cash Price |
$46.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$44.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$44.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$46.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$49.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$46.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.72
|
| Rate for Payer: Healthfirst QHP |
$49.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$49.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$41.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$49.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$129.10
|
| Rate for Payer: SOMOS Essential |
$129.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$49.18
|
|
|
CHG RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST
|
Professional
|
$137.87
|
|
|
Service Code
|
HCPCS 73565 TC
|
| Min. Negotiated Rate |
$6.85 |
| Max. Negotiated Rate |
$129.10 |
| Rate for Payer: Cash Price |
$37.95
|
| Rate for Payer: Cash Price |
$37.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$39.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.42
|
| Rate for Payer: Healthfirst QHP |
$39.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$39.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$103.40
|
| Rate for Payer: SOMOS Essential |
$103.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.39
|
|
|
CHG RADIOLOGIC EXAM CHEST 2 VIEWS
|
Professional
|
$143.71
|
|
|
Service Code
|
HCPCS 71046
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$107.78 |
| Rate for Payer: Cash Price |
$39.18
|
| Rate for Payer: Cash Price |
$39.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$39.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$39.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.01
|
| Rate for Payer: Healthfirst QHP |
$41.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$41.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$107.78
|
| Rate for Payer: SOMOS Essential |
$107.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.06
|
|
|
CHG RADIOLOGIC EXAM CHEST 2 VIEWS
|
Professional
|
$41.79
|
|
|
Service Code
|
HCPCS 71046 26
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$107.78 |
| 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 RADIOLOGIC EXAM CHEST 2 VIEWS
|
Professional
|
$101.92
|
|
|
Service Code
|
HCPCS 71046 TC
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$107.78 |
| 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
|
|
