|
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
|
|
|
CHG RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS
|
Professional
|
$190.05
|
|
|
Service Code
|
HCPCS 70260
|
| Min. Negotiated Rate |
$10.72 |
| Max. Negotiated Rate |
$142.54 |
| Rate for Payer: Cash Price |
$51.88
|
| Rate for Payer: Cash Price |
$51.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$48.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$48.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$51.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$54.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$51.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$51.58
|
| Rate for Payer: Healthfirst QHP |
$54.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$38.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$54.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$46.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$38.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$54.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$142.54
|
| Rate for Payer: SOMOS Essential |
$142.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.30
|
|
|
CHG RADIOLOGIC EXAM SMALL INT DOUBLE CONTRAST STUDY
|
Professional
|
$767.48
|
|
|
Service Code
|
HCPCS 74251 TC
|
| Min. Negotiated Rate |
$44.95 |
| Max. Negotiated Rate |
$744.19 |
| Rate for Payer: Cash Price |
$362.91
|
| Rate for Payer: Cash Price |
$362.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$354.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$354.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$373.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$393.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$373.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$393.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$393.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$295.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$373.75
|
| Rate for Payer: Healthfirst QHP |
$393.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$275.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$393.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$334.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$275.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$393.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$575.61
|
| Rate for Payer: SOMOS Essential |
$575.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$393.42
|
|
|
CHG RADIOLOGIC EXAM SMALL INT DOUBLE CONTRAST STUDY
|
Professional
|
$992.25
|
|
|
Service Code
|
HCPCS 74251
|
| Min. Negotiated Rate |
$44.95 |
| Max. Negotiated Rate |
$744.19 |
| Rate for Payer: Cash Price |
$423.57
|
| Rate for Payer: Cash Price |
$423.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$411.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$411.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$434.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$457.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$434.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$457.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$457.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$343.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$434.76
|
| Rate for Payer: Healthfirst QHP |
$457.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$320.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$457.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$388.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$320.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$457.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$744.19
|
| Rate for Payer: SOMOS Essential |
$744.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$457.64
|
|
|
CHG RADIOLOGIC EXAM SMALL INT DOUBLE CONTRAST STUDY
|
Professional
|
$224.77
|
|
|
Service Code
|
HCPCS 74251 26
|
| Min. Negotiated Rate |
$44.95 |
| Max. Negotiated Rate |
$744.19 |
| Rate for Payer: Cash Price |
$60.67
|
| Rate for Payer: Cash Price |
$60.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$57.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$57.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$61.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$64.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$61.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$64.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$64.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$48.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.01
|
| Rate for Payer: Healthfirst QHP |
$64.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$44.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$64.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$54.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$44.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$64.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$168.58
|
| Rate for Payer: SOMOS Essential |
$168.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$64.22
|
|
|
CHG RADIOLOGIC EXAM SMALL INT SINGLE CONTRAST STUDY
|
Professional
|
$526.26
|
|
|
Service Code
|
HCPCS 74250
|
| Min. Negotiated Rate |
$30.81 |
| Max. Negotiated Rate |
$394.70 |
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$135.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$135.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$142.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$150.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$142.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$112.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$142.84
|
| Rate for Payer: Healthfirst QHP |
$150.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$105.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$150.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$127.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$105.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$150.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$394.70
|
| Rate for Payer: SOMOS Essential |
$394.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$150.36
|
|
|
CHG RADIOLOGIC EXAM SMALL INT SINGLE CONTRAST STUDY
|
Professional
|
$372.16
|
|
|
Service Code
|
HCPCS 74250 TC
|
| Min. Negotiated Rate |
$30.81 |
| Max. Negotiated Rate |
$394.70 |
| Rate for Payer: Cash Price |
$99.25
|
| Rate for Payer: Cash Price |
$99.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$95.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$95.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$101.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$106.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$101.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$106.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$79.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$101.01
|
| Rate for Payer: Healthfirst QHP |
$106.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$74.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$106.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$90.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$74.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$106.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$279.12
|
| Rate for Payer: SOMOS Essential |
$279.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$106.33
|
|
|
CHG RADIOLOGIC EXAM SMALL INT SINGLE CONTRAST STUDY
|
Professional
|
$154.07
|
|
|
Service Code
|
HCPCS 74250 26
|
| Min. Negotiated Rate |
$30.81 |
| Max. Negotiated Rate |
$394.70 |
| Rate for Payer: Cash Price |
$41.75
|
| Rate for Payer: Cash Price |
$41.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$44.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.82
|
| Rate for Payer: Healthfirst QHP |
$44.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$44.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$37.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$44.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$115.55
|
| Rate for Payer: SOMOS Essential |
$115.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44.02
|
|
|
CHG RADIOLOGIC EXAM SWALLOW FUNCTION CONTRAST STUDY
|
Professional
|
$104.65
|
|
|
Service Code
|
HCPCS 74230 26
|
| Min. Negotiated Rate |
$20.93 |
| Max. Negotiated Rate |
$409.37 |
| Rate for Payer: Cash Price |
$27.83
|
| Rate for Payer: Cash Price |
$27.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$28.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.40
|
| Rate for Payer: Healthfirst QHP |
$29.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$25.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$78.49
|
| Rate for Payer: SOMOS Essential |
$78.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.90
|
|
|
CHG RADIOLOGIC EXAM SWALLOW FUNCTION CONTRAST STUDY
|
Professional
|
$441.18
|
|
|
Service Code
|
HCPCS 74230 TC
|
| Min. Negotiated Rate |
$20.93 |
| Max. Negotiated Rate |
$409.37 |
| Rate for Payer: Cash Price |
$117.72
|
| Rate for Payer: Cash Price |
$117.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$113.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$113.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$119.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$126.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$119.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$94.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$119.75
|
| Rate for Payer: Healthfirst QHP |
$126.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$88.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$126.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$107.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$88.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$126.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$330.88
|
| Rate for Payer: SOMOS Essential |
$330.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$126.05
|
|
|
CHG RADIOLOGIC EXAM SWALLOW FUNCTION CONTRAST STUDY
|
Professional
|
$545.83
|
|
|
Service Code
|
HCPCS 74230
|
| Min. Negotiated Rate |
$20.93 |
| Max. Negotiated Rate |
$409.37 |
| Rate for Payer: Cash Price |
$145.54
|
| Rate for Payer: Cash Price |
$145.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$140.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$140.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$148.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$155.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$148.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$155.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$155.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$116.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$148.15
|
| Rate for Payer: Healthfirst QHP |
$155.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$109.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$155.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$132.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$109.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$155.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$409.37
|
| Rate for Payer: SOMOS Essential |
$409.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$155.95
|
|
|
CHG RADIOLOGIC EXAM TEETH COMPLETE FULL MOUTH
|
Professional
|
$182.42
|
|
|
Service Code
|
HCPCS 70320 TC
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$169.24 |
| Rate for Payer: Cash Price |
$50.53
|
| Rate for Payer: Cash Price |
$50.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$46.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$46.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.51
|
| Rate for Payer: Healthfirst QHP |
$52.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$136.82
|
| Rate for Payer: SOMOS Essential |
$136.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.12
|
|
|
CHG RADIOLOGIC EXAM TEETH COMPLETE FULL MOUTH
|
Professional
|
$225.65
|
|
|
Service Code
|
HCPCS 70320
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$169.24 |
| Rate for Payer: Cash Price |
$62.36
|
| Rate for Payer: Cash Price |
$62.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$58.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$61.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$64.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$61.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$64.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$64.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$48.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.25
|
| Rate for Payer: Healthfirst QHP |
$64.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$64.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$54.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$64.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$169.24
|
| Rate for Payer: SOMOS Essential |
$169.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$64.47
|
|
|
CHG RADIOLOGIC EXAM TEETH COMPLETE FULL MOUTH
|
Professional
|
$43.23
|
|
|
Service Code
|
HCPCS 70320 26
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$169.24 |
| Rate for Payer: Cash Price |
$11.83
|
| Rate for Payer: Cash Price |
$11.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.73
|
| Rate for Payer: Healthfirst QHP |
$12.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$12.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$10.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.42
|
| Rate for Payer: SOMOS Essential |
$32.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.35
|
|
|
CHG RADIOLOGIC EXAM TEETH PRTL EXAM < FULL MOUTH
|
Professional
|
$31.40
|
|
|
Service Code
|
HCPCS 70310 26
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$126.94 |
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Cash Price |
$8.96
|
| 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 TEETH PRTL EXAM < FULL MOUTH
|
Professional
|
$169.26
|
|
|
Service Code
|
HCPCS 70310
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$126.94 |
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$48.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$45.94
|
| Rate for Payer: Healthfirst QHP |
$48.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$33.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$48.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$41.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$33.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$48.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$126.94
|
| Rate for Payer: SOMOS Essential |
$126.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$48.36
|
|
|
CHG RADIOLOGIC EXAM TEETH PRTL EXAM < FULL MOUTH
|
Professional
|
$137.87
|
|
|
Service Code
|
HCPCS 70310 TC
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$126.94 |
| Rate for Payer: Cash Price |
$38.74
|
| Rate for Payer: Cash Price |
$38.74
|
| 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 UPR GI TRC DOUBLE CONTRAST STUDY
|
Professional
|
$429.66
|
|
|
Service Code
|
HCPCS 74246 TC
|
| Min. Negotiated Rate |
$33.94 |
| Max. Negotiated Rate |
$449.50 |
| Rate for Payer: Cash Price |
$114.58
|
| Rate for Payer: Cash Price |
$114.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$110.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$110.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$116.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$122.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$116.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$122.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$122.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$92.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$116.62
|
| Rate for Payer: Healthfirst QHP |
$122.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$85.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$122.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$104.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$85.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$122.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$322.24
|
| Rate for Payer: SOMOS Essential |
$322.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$122.76
|
|
|
CHG RADIOLOGIC EXAM UPR GI TRC DOUBLE CONTRAST STUDY
|
Professional
|
$169.68
|
|
|
Service Code
|
HCPCS 74246 26
|
| Min. Negotiated Rate |
$33.94 |
| Max. Negotiated Rate |
$449.50 |
| Rate for Payer: Cash Price |
$46.69
|
| Rate for Payer: Cash Price |
$46.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$46.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$48.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$46.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.06
|
| Rate for Payer: Healthfirst QHP |
$48.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$33.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$48.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$41.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$33.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$48.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$127.26
|
| Rate for Payer: SOMOS Essential |
$127.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$48.48
|
|
|
CHG RADIOLOGIC EXAM UPR GI TRC DOUBLE CONTRAST STUDY
|
Professional
|
$599.34
|
|
|
Service Code
|
HCPCS 74246
|
| Min. Negotiated Rate |
$33.94 |
| Max. Negotiated Rate |
$449.50 |
| Rate for Payer: Cash Price |
$161.27
|
| Rate for Payer: Cash Price |
$161.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$154.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$154.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$162.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$171.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$162.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$171.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$171.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$128.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$162.68
|
| Rate for Payer: Healthfirst QHP |
$171.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$119.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$171.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$145.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$119.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$171.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$449.50
|
| Rate for Payer: SOMOS Essential |
$449.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$171.24
|
|
|
CHG RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST STUDY
|
Professional
|
$375.06
|
|
|
Service Code
|
HCPCS 74240 TC
|
| Min. Negotiated Rate |
$30.86 |
| Max. Negotiated Rate |
$396.98 |
| Rate for Payer: Cash Price |
$100.43
|
| Rate for Payer: Cash Price |
$100.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$96.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$96.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$101.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$107.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$101.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$107.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$101.80
|
| Rate for Payer: Healthfirst QHP |
$107.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$75.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$107.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$91.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$75.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$107.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$281.30
|
| Rate for Payer: SOMOS Essential |
$281.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$107.16
|
|
|
CHG RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST STUDY
|
Professional
|
$154.28
|
|
|
Service Code
|
HCPCS 74240 26
|
| Min. Negotiated Rate |
$30.86 |
| Max. Negotiated Rate |
$396.98 |
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$44.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.88
|
| Rate for Payer: Healthfirst QHP |
$44.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$44.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$37.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$44.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$115.71
|
| Rate for Payer: SOMOS Essential |
$115.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44.08
|
|
|
CHG RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST STUDY
|
Professional
|
$529.31
|
|
|
Service Code
|
HCPCS 74240
|
| Min. Negotiated Rate |
$30.86 |
| Max. Negotiated Rate |
$396.98 |
| Rate for Payer: Cash Price |
$142.23
|
| Rate for Payer: Cash Price |
$142.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$136.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$136.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$143.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$151.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$143.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$151.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$151.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$113.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$143.67
|
| Rate for Payer: Healthfirst QHP |
$151.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$105.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$151.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$128.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$105.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$151.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$396.98
|
| Rate for Payer: SOMOS Essential |
$396.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$151.23
|
|
|
CHG RADIOLOGIC SMALL INTESTINE FOLLOW-THROUGH STUDY
|
Professional
|
$354.34
|
|
|
Service Code
|
HCPCS 74248
|
| Min. Negotiated Rate |
$26.91 |
| Max. Negotiated Rate |
$265.76 |
| Rate for Payer: Cash Price |
$95.12
|
| Rate for Payer: Cash Price |
$95.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$91.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$91.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$96.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$101.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$96.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$101.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$101.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$75.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$96.18
|
| Rate for Payer: Healthfirst QHP |
$101.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$70.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$101.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$86.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$70.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$101.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$265.76
|
| Rate for Payer: SOMOS Essential |
$265.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$101.24
|
|
|
CHG RADIOLOGIC SMALL INTESTINE FOLLOW-THROUGH STUDY
|
Professional
|
$219.80
|
|
|
Service Code
|
HCPCS 74248 TC
|
| Min. Negotiated Rate |
$26.91 |
| Max. Negotiated Rate |
$265.76 |
| Rate for Payer: Cash Price |
$58.78
|
| Rate for Payer: Cash Price |
$58.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$56.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$56.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$59.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$59.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$62.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$59.66
|
| Rate for Payer: Healthfirst QHP |
$62.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$43.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$62.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$53.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$43.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$164.85
|
| Rate for Payer: SOMOS Essential |
$164.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.80
|
|
