|
CHG RADIOLOGIC EXAMINATION NECK SOFT TISSUE
|
Professional
|
$35.35
|
|
|
Service Code
|
HCPCS 70360 26
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$101.88 |
| 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 EXAMINATION OSSEOUS SURVEY COMPL
|
Professional
|
$108.57
|
|
|
Service Code
|
HCPCS 77075 26
|
| Min. Negotiated Rate |
$21.71 |
| Max. Negotiated Rate |
$321.64 |
| Rate for Payer: Cash Price |
$28.92
|
| Rate for Payer: Cash Price |
$28.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$27.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.47
|
| Rate for Payer: Healthfirst QHP |
$31.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$31.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$26.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$81.43
|
| Rate for Payer: SOMOS Essential |
$81.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.02
|
|
|
CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY COMPL
|
Professional
|
$320.29
|
|
|
Service Code
|
HCPCS 77075 TC
|
| Min. Negotiated Rate |
$21.71 |
| Max. Negotiated Rate |
$321.64 |
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$82.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$82.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$86.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$91.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$86.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$91.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$68.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$86.93
|
| Rate for Payer: Healthfirst QHP |
$91.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$91.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$77.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$91.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$240.22
|
| Rate for Payer: SOMOS Essential |
$240.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$91.51
|
|
|
CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY COMPL
|
Professional
|
$428.86
|
|
|
Service Code
|
HCPCS 77075
|
| Min. Negotiated Rate |
$21.71 |
| Max. Negotiated Rate |
$321.64 |
| Rate for Payer: Cash Price |
$116.22
|
| Rate for Payer: Cash Price |
$116.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$110.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$110.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$116.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$122.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$116.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$122.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$122.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$91.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$116.40
|
| Rate for Payer: Healthfirst QHP |
$122.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$85.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$122.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$104.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$85.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$122.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$321.64
|
| Rate for Payer: SOMOS Essential |
$321.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$122.53
|
|
|
CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY INFANT
|
Professional
|
$323.16
|
|
|
Service Code
|
HCPCS 77076 TC
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$344.38 |
| Rate for Payer: Cash Price |
$88.09
|
| Rate for Payer: Cash Price |
$88.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$83.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$83.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$87.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$92.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$87.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$87.71
|
| Rate for Payer: Healthfirst QHP |
$92.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$92.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$78.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$92.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$242.37
|
| Rate for Payer: SOMOS Essential |
$242.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$92.33
|
|
|
CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY INFANT
|
Professional
|
$459.17
|
|
|
Service Code
|
HCPCS 77076
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$344.38 |
| Rate for Payer: Cash Price |
$124.83
|
| Rate for Payer: Cash Price |
$124.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$118.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$118.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$124.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$131.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$124.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$131.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$131.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$98.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$124.63
|
| Rate for Payer: Healthfirst QHP |
$131.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$91.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$131.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$111.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$91.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$131.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$344.38
|
| Rate for Payer: SOMOS Essential |
$344.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$131.19
|
|
|
CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY INFANT
|
Professional
|
$136.01
|
|
|
Service Code
|
HCPCS 77076 26
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$344.38 |
| Rate for Payer: Cash Price |
$36.74
|
| Rate for Payer: Cash Price |
$36.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.92
|
| Rate for Payer: Healthfirst QHP |
$38.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$102.01
|
| Rate for Payer: SOMOS Essential |
$102.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.86
|
|
|
CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY LIMITED
|
Professional
|
$192.50
|
|
|
Service Code
|
HCPCS 77074 TC
|
| Min. Negotiated Rate |
$16.72 |
| Max. Negotiated Rate |
$207.06 |
| Rate for Payer: Cash Price |
$52.89
|
| Rate for Payer: Cash Price |
$52.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$49.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$49.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$52.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$55.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$52.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$52.25
|
| Rate for Payer: Healthfirst QHP |
$55.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$38.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$55.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$46.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$38.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$55.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$144.38
|
| Rate for Payer: SOMOS Essential |
$144.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.00
|
|
|
CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY LIMITED
|
Professional
|
$83.58
|
|
|
Service Code
|
HCPCS 77074 26
|
| Min. Negotiated Rate |
$16.72 |
| Max. Negotiated Rate |
$207.06 |
| Rate for Payer: Cash Price |
$22.88
|
| Rate for Payer: Cash Price |
$22.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$23.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22.69
|
| Rate for Payer: Healthfirst QHP |
$23.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$16.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$23.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$20.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$16.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$62.68
|
| Rate for Payer: SOMOS Essential |
$62.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.88
|
|
|
CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY LIMITED
|
Professional
|
$276.08
|
|
|
Service Code
|
HCPCS 77074
|
| Min. Negotiated Rate |
$16.72 |
| Max. Negotiated Rate |
$207.06 |
| Rate for Payer: Cash Price |
$75.77
|
| Rate for Payer: Cash Price |
$75.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$70.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$70.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$74.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$78.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$74.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$78.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$78.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$59.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$74.94
|
| Rate for Payer: Healthfirst QHP |
$78.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$55.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$78.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$67.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$55.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$78.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$207.06
|
| Rate for Payer: SOMOS Essential |
$207.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$78.88
|
|
|
CHG RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS
|
Professional
|
$120.19
|
|
|
Service Code
|
HCPCS 72170
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$90.14 |
| Rate for Payer: Cash Price |
$32.72
|
| Rate for Payer: Cash Price |
$32.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.62
|
| Rate for Payer: Healthfirst QHP |
$34.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$34.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$90.14
|
| Rate for Payer: SOMOS Essential |
$90.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.34
|
|
|
CHG RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS
|
Professional
|
$34.09
|
|
|
Service Code
|
HCPCS 72170 26
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$90.14 |
| 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 RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS
|
Professional
|
$86.10
|
|
|
Service Code
|
HCPCS 72170 TC
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$90.14 |
| Rate for Payer: Cash Price |
$23.42
|
| Rate for Payer: Cash Price |
$23.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23.37
|
| Rate for Payer: Healthfirst QHP |
$24.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$24.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$20.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$64.58
|
| Rate for Payer: SOMOS Essential |
$64.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.60
|
|
|
CHG RADIOLOGIC EXAMINATION SACROILIAC JNTS <3 VIEWS
|
Professional
|
$141.75
|
|
|
Service Code
|
HCPCS 72200
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$106.31 |
| Rate for Payer: Cash Price |
$39.01
|
| Rate for Payer: Cash Price |
$39.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.48
|
| Rate for Payer: Healthfirst QHP |
$40.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$40.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$106.31
|
| Rate for Payer: SOMOS Essential |
$106.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.50
|
|
|
CHG RADIOLOGIC EXAMINATION SACROILIAC JNTS <3 VIEWS
|
Professional
|
$109.10
|
|
|
Service Code
|
HCPCS 72200 TC
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$106.31 |
| Rate for Payer: Cash Price |
$30.10
|
| Rate for Payer: Cash Price |
$30.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.61
|
| Rate for Payer: Healthfirst QHP |
$31.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$31.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$26.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$81.82
|
| Rate for Payer: SOMOS Essential |
$81.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.17
|
|
|
CHG RADIOLOGIC EXAMINATION SACROILIAC JNTS <3 VIEWS
|
Professional
|
$32.66
|
|
|
Service Code
|
HCPCS 72200 26
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$106.31 |
| Rate for Payer: Cash Price |
$8.91
|
| Rate for Payer: Cash Price |
$8.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.86
|
| Rate for Payer: Healthfirst QHP |
$9.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.50
|
| Rate for Payer: SOMOS Essential |
$24.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.33
|
|
|
CHG RADIOLOGIC EXAMINATION SALIVARY GLAND CALCULUS
|
Professional
|
$129.22
|
|
|
Service Code
|
HCPCS 70380 TC
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$121.41 |
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.07
|
| Rate for Payer: Healthfirst QHP |
$36.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$36.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$31.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$96.92
|
| Rate for Payer: SOMOS Essential |
$96.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.92
|
|
|
CHG RADIOLOGIC EXAMINATION SALIVARY GLAND CALCULUS
|
Professional
|
$32.66
|
|
|
Service Code
|
HCPCS 70380 26
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$121.41 |
| Rate for Payer: Cash Price |
$8.91
|
| Rate for Payer: Cash Price |
$8.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.86
|
| Rate for Payer: Healthfirst QHP |
$9.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.50
|
| Rate for Payer: SOMOS Essential |
$24.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.33
|
|
|
CHG RADIOLOGIC EXAMINATION SALIVARY GLAND CALCULUS
|
Professional
|
$161.88
|
|
|
Service Code
|
HCPCS 70380
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$121.41 |
| Rate for Payer: Cash Price |
$44.12
|
| Rate for Payer: Cash Price |
$44.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$41.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$43.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43.94
|
| Rate for Payer: Healthfirst QHP |
$46.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$46.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$39.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$121.41
|
| Rate for Payer: SOMOS Essential |
$121.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.25
|
|
|
CHG RADIOLOGIC EXAMINATION SELLA TURCICA
|
Professional
|
$141.40
|
|
|
Service Code
|
HCPCS 70240
|
| Min. Negotiated Rate |
$7.32 |
| Max. Negotiated Rate |
$106.05 |
| Rate for Payer: Cash Price |
$38.53
|
| Rate for Payer: Cash Price |
$38.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.38
|
| Rate for Payer: Healthfirst QHP |
$40.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$40.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$106.05
|
| Rate for Payer: SOMOS Essential |
$106.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.40
|
|
|
CHG RADIOLOGIC EXAMINATION SELLA TURCICA
|
Professional
|
$104.79
|
|
|
Service Code
|
HCPCS 70240 TC
|
| Min. Negotiated Rate |
$7.32 |
| Max. Negotiated Rate |
$106.05 |
| 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 RADIOLOGIC EXAMINATION SELLA TURCICA
|
Professional
|
$36.61
|
|
|
Service Code
|
HCPCS 70240 26
|
| Min. Negotiated Rate |
$7.32 |
| Max. Negotiated Rate |
$106.05 |
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.94
|
| Rate for Payer: Healthfirst QHP |
$10.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$7.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$10.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.46
|
| Rate for Payer: SOMOS Essential |
$27.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.46
|
|
|
CHG RADIOLOGIC EXAMINATION SKULL 4< VIEWS
|
Professional
|
$119.18
|
|
|
Service Code
|
HCPCS 70250 TC
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$115.90 |
| Rate for Payer: Cash Price |
$32.45
|
| Rate for Payer: Cash Price |
$32.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.35
|
| Rate for Payer: Healthfirst QHP |
$34.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$34.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$89.38
|
| Rate for Payer: SOMOS Essential |
$89.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.05
|
|
|
CHG RADIOLOGIC EXAMINATION SKULL 4< VIEWS
|
Professional
|
$35.35
|
|
|
Service Code
|
HCPCS 70250 26
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$115.90 |
| 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 EXAMINATION SKULL 4< VIEWS
|
Professional
|
$154.53
|
|
|
Service Code
|
HCPCS 70250
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$115.90 |
| Rate for Payer: Cash Price |
$42.11
|
| Rate for Payer: Cash Price |
$42.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$44.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.94
|
| Rate for Payer: Healthfirst QHP |
$44.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$44.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$37.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$44.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$115.90
|
| Rate for Payer: SOMOS Essential |
$115.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44.15
|
|
