|
CHG RADIOLOGIC EXAMINATION TEETH 1 VIEW
|
Professional
|
$35.81
|
|
|
Service Code
|
HCPCS 70300 TC
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$42.61 |
| Rate for Payer: Cash Price |
$9.66
|
| Rate for Payer: Cash Price |
$9.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.72
|
| Rate for Payer: Healthfirst QHP |
$10.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$7.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$10.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.86
|
| Rate for Payer: SOMOS Essential |
$26.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.23
|
|
|
CHG RADIOLOGIC EXAMINATION TEETH 1 VIEW
|
Professional
|
$56.81
|
|
|
Service Code
|
HCPCS 70300
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$42.61 |
| Rate for Payer: Cash Price |
$15.35
|
| Rate for Payer: Cash Price |
$15.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.42
|
| Rate for Payer: Healthfirst QHP |
$16.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$16.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$13.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$42.61
|
| Rate for Payer: SOMOS Essential |
$42.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.23
|
|
|
CHG RADIOLOGIC EXAMINATION TEETH 1 VIEW
|
Professional
|
$21.00
|
|
|
Service Code
|
HCPCS 70300 26
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$42.61 |
| Rate for Payer: Cash Price |
$5.68
|
| Rate for Payer: Cash Price |
$5.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.70
|
| Rate for Payer: Healthfirst QHP |
$6.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$4.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$6.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$5.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$4.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.75
|
| Rate for Payer: SOMOS Essential |
$15.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.00
|
|
|
CHG RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS
|
Professional
|
$104.79
|
|
|
Service Code
|
HCPCS 73590 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 RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS
|
Professional
|
$136.19
|
|
|
Service Code
|
HCPCS 73590
|
| 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 RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS
|
Professional
|
$31.40
|
|
|
Service Code
|
HCPCS 73590 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 RADIOLOGIC EXAM KNEE ARTHROGRAPHY RS&I
|
Professional
|
$126.25
|
|
|
Service Code
|
HCPCS 73580 26
|
| Min. Negotiated Rate |
$25.25 |
| Max. Negotiated Rate |
$412.63 |
| Rate for Payer: Cash Price |
$34.55
|
| Rate for Payer: Cash Price |
$34.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.27
|
| Rate for Payer: Healthfirst QHP |
$36.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$36.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$94.69
|
| Rate for Payer: SOMOS Essential |
$94.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.07
|
|
|
CHG RADIOLOGIC EXAM KNEE ARTHROGRAPHY RS&I
|
Professional
|
$423.92
|
|
|
Service Code
|
HCPCS 73580 TC
|
| Min. Negotiated Rate |
$25.25 |
| Max. Negotiated Rate |
$412.63 |
| Rate for Payer: Cash Price |
$94.93
|
| Rate for Payer: Cash Price |
$94.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$109.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$109.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$115.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$121.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$115.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$121.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$121.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$90.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$115.06
|
| Rate for Payer: Healthfirst QHP |
$121.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$84.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$121.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$102.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$84.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$121.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$317.94
|
| Rate for Payer: SOMOS Essential |
$317.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$121.12
|
|
|
CHG RADIOLOGIC EXAM KNEE ARTHROGRAPHY RS&I
|
Professional
|
$550.17
|
|
|
Service Code
|
HCPCS 73580
|
| Min. Negotiated Rate |
$25.25 |
| Max. Negotiated Rate |
$412.63 |
| Rate for Payer: Cash Price |
$129.47
|
| Rate for Payer: Cash Price |
$129.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$141.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$149.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$149.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$117.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$149.33
|
| Rate for Payer: Healthfirst QHP |
$157.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$110.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$157.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$133.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$110.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$412.63
|
| Rate for Payer: SOMOS Essential |
$412.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.19
|
|
|
CHG RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS
|
Professional
|
$155.12
|
|
|
Service Code
|
HCPCS 73564 TC
|
| Min. Negotiated Rate |
$8.93 |
| Max. Negotiated Rate |
$149.84 |
| Rate for Payer: Cash Price |
$43.06
|
| Rate for Payer: Cash Price |
$43.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$42.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$44.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$42.10
|
| Rate for Payer: Healthfirst QHP |
$44.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$44.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$37.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$44.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$116.34
|
| Rate for Payer: SOMOS Essential |
$116.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44.32
|
|
|
CHG RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS
|
Professional
|
$199.78
|
|
|
Service Code
|
HCPCS 73564
|
| Min. Negotiated Rate |
$8.93 |
| Max. Negotiated Rate |
$149.84 |
| Rate for Payer: Cash Price |
$55.29
|
| Rate for Payer: Cash Price |
$55.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$51.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$51.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$54.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$57.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$54.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$54.23
|
| Rate for Payer: Healthfirst QHP |
$57.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$39.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$57.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$48.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$39.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$57.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$149.84
|
| Rate for Payer: SOMOS Essential |
$149.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$57.08
|
|
|
CHG RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS
|
Professional
|
$44.66
|
|
|
Service Code
|
HCPCS 73564 26
|
| Min. Negotiated Rate |
$8.93 |
| Max. Negotiated Rate |
$149.84 |
| Rate for Payer: Cash Price |
$12.23
|
| Rate for Payer: Cash Price |
$12.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.12
|
| Rate for Payer: Healthfirst QHP |
$12.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$12.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$10.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$33.50
|
| Rate for Payer: SOMOS Essential |
$33.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.76
|
|
|
CHG RADIOLOGIC EXAM MASTOIDS < 3 VIEWS PER SIDE
|
Professional
|
$166.01
|
|
|
Service Code
|
HCPCS 70120
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$124.51 |
| Rate for Payer: Cash Price |
$44.86
|
| Rate for Payer: Cash Price |
$44.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$42.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$45.06
|
| Rate for Payer: Healthfirst QHP |
$47.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$33.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$47.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$40.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$33.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$124.51
|
| Rate for Payer: SOMOS Essential |
$124.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.43
|
|
|
CHG RADIOLOGIC EXAM MASTOIDS < 3 VIEWS PER SIDE
|
Professional
|
$35.35
|
|
|
Service Code
|
HCPCS 70120 26
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$124.51 |
| 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 MASTOIDS < 3 VIEWS PER SIDE
|
Professional
|
$130.69
|
|
|
Service Code
|
HCPCS 70120 TC
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$124.51 |
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.47
|
| Rate for Payer: Healthfirst QHP |
$37.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$37.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$31.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$98.02
|
| Rate for Payer: SOMOS Essential |
$98.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.34
|
|
|
CHG RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS
|
Professional
|
$180.53
|
|
|
Service Code
|
HCPCS 72190
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$135.40 |
| Rate for Payer: Cash Price |
$49.26
|
| Rate for Payer: Cash Price |
$49.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$46.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$46.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$51.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.00
|
| Rate for Payer: Healthfirst QHP |
$51.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$51.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$43.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$51.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$135.40
|
| Rate for Payer: SOMOS Essential |
$135.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$51.58
|
|
|
CHG RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS
|
Professional
|
$48.44
|
|
|
Service Code
|
HCPCS 72190 26
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$135.40 |
| Rate for Payer: Cash Price |
$13.27
|
| Rate for Payer: Cash Price |
$13.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.15
|
| Rate for Payer: Healthfirst QHP |
$13.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$13.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$11.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$36.33
|
| Rate for Payer: SOMOS Essential |
$36.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.84
|
|
|
CHG RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS
|
Professional
|
$132.13
|
|
|
Service Code
|
HCPCS 72190 TC
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$135.40 |
| 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 PHRNX&/CRV ESOPH CONTRAST STUDY
|
Professional
|
$300.30
|
|
|
Service Code
|
HCPCS 74210 TC
|
| Min. Negotiated Rate |
$23.01 |
| Max. Negotiated Rate |
$311.48 |
| Rate for Payer: Cash Price |
$79.60
|
| Rate for Payer: Cash Price |
$79.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$77.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$77.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$81.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$85.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$81.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$81.51
|
| Rate for Payer: Healthfirst QHP |
$85.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$60.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$85.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$72.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$60.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$85.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$225.22
|
| Rate for Payer: SOMOS Essential |
$225.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$85.80
|
|
|
CHG RADIOLOGIC EXAM PHRNX&/CRV ESOPH CONTRAST STUDY
|
Professional
|
$415.31
|
|
|
Service Code
|
HCPCS 74210
|
| Min. Negotiated Rate |
$23.01 |
| Max. Negotiated Rate |
$311.48 |
| Rate for Payer: Cash Price |
$109.92
|
| Rate for Payer: Cash Price |
$109.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$106.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$106.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$112.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$118.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$112.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$118.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$118.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$89.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$112.73
|
| Rate for Payer: Healthfirst QHP |
$118.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$83.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$118.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$100.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$83.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$118.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$311.48
|
| Rate for Payer: SOMOS Essential |
$311.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$118.66
|
|
|
CHG RADIOLOGIC EXAM PHRNX&/CRV ESOPH CONTRAST STUDY
|
Professional
|
$115.05
|
|
|
Service Code
|
HCPCS 74210 26
|
| Min. Negotiated Rate |
$23.01 |
| Max. Negotiated Rate |
$311.48 |
| Rate for Payer: Cash Price |
$30.31
|
| Rate for Payer: Cash Price |
$30.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.23
|
| Rate for Payer: Healthfirst QHP |
$32.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$86.29
|
| Rate for Payer: SOMOS Essential |
$86.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.87
|
|
|
CHG RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE VIEWS
|
Professional
|
$167.97
|
|
|
Service Code
|
HCPCS 72202
|
| Min. Negotiated Rate |
$8.61 |
| Max. Negotiated Rate |
$125.98 |
| Rate for Payer: Cash Price |
$45.81
|
| Rate for Payer: Cash Price |
$45.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$45.59
|
| Rate for Payer: Healthfirst QHP |
$47.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$33.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$47.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$40.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$33.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$125.98
|
| Rate for Payer: SOMOS Essential |
$125.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.99
|
|
|
CHG RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE VIEWS
|
Professional
|
$124.92
|
|
|
Service Code
|
HCPCS 72202 TC
|
| Min. Negotiated Rate |
$8.61 |
| Max. Negotiated Rate |
$125.98 |
| Rate for Payer: Cash Price |
$34.02
|
| Rate for Payer: Cash Price |
$34.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.91
|
| Rate for Payer: Healthfirst QHP |
$35.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$35.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$93.69
|
| Rate for Payer: SOMOS Essential |
$93.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.69
|
|
|
CHG RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE VIEWS
|
Professional
|
$43.05
|
|
|
Service Code
|
HCPCS 72202 26
|
| Min. Negotiated Rate |
$8.61 |
| Max. Negotiated Rate |
$125.98 |
| Rate for Payer: Cash Price |
$11.79
|
| Rate for Payer: Cash Price |
$11.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.68
|
| Rate for Payer: Healthfirst QHP |
$12.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$12.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$10.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.29
|
| Rate for Payer: SOMOS Essential |
$32.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.30
|
|
|
CHG RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS
|
Professional
|
$136.43
|
|
|
Service Code
|
HCPCS 70260 TC
|
| Min. Negotiated Rate |
$10.72 |
| Max. Negotiated Rate |
$142.54 |
| Rate for Payer: Cash Price |
$37.17
|
| Rate for Payer: Cash Price |
$37.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.03
|
| Rate for Payer: Healthfirst QHP |
$38.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$102.32
|
| Rate for Payer: SOMOS Essential |
$102.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.98
|
|
