|
X-RAY EXAM OF PELVIS 3+ VIEWS
|
Facility
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 72190
|
| Hospital Charge Code |
4150129
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.20 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna of NY Commercial |
$189.00
|
| Rate for Payer: Aetna of NY Medicare |
$144.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$116.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$157.50
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: CDPHP Commercial |
$253.58
|
| Rate for Payer: CDPHP Medicare |
$116.55
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$252.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$252.00
|
| Rate for Payer: EmblemHealth Medicaid |
$252.00
|
| Rate for Payer: EmblemHealth Medicare |
$107.10
|
| Rate for Payer: Fidelis Medicare |
$120.05
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$116.55
|
| Rate for Payer: Humana Medicare |
$116.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$189.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$144.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$236.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$177.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$122.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$390.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$20.20
|
| Rate for Payer: United Healthcare Commercial |
$390.00
|
| Rate for Payer: United Healthcare Medicare |
$116.55
|
| Rate for Payer: WellCare Medicare |
$173.25
|
|
|
X-RAY EXAM OF RIBS 2 VIEWS UNILAT, LEFT
|
Facility
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 71100 LT
|
| Hospital Charge Code |
4150157
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna of NY Commercial |
$156.00
|
| Rate for Payer: Aetna of NY Medicare |
$119.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$96.20
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$130.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: CDPHP Commercial |
$209.30
|
| Rate for Payer: CDPHP Medicare |
$96.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$208.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$208.00
|
| Rate for Payer: EmblemHealth Medicaid |
$208.00
|
| Rate for Payer: EmblemHealth Medicare |
$88.40
|
| Rate for Payer: Fidelis Medicare |
$99.09
|
| Rate for Payer: Galaxy Health Commercial |
$169.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$96.20
|
| Rate for Payer: Humana Medicare |
$96.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$156.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$119.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$195.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$146.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$101.01
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$390.00
|
| Rate for Payer: United Healthcare Commercial |
$390.00
|
| Rate for Payer: United Healthcare Medicare |
$96.20
|
| Rate for Payer: WellCare Medicare |
$143.00
|
|
|
X-RAY EXAM OF RIBS 2 VIEWS UNILAT, RIGHT
|
Facility
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 71100 RT
|
| Hospital Charge Code |
4150158
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna of NY Commercial |
$156.00
|
| Rate for Payer: Aetna of NY Medicare |
$119.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$96.20
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$130.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: CDPHP Commercial |
$209.30
|
| Rate for Payer: CDPHP Medicare |
$96.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$208.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$208.00
|
| Rate for Payer: EmblemHealth Medicaid |
$208.00
|
| Rate for Payer: EmblemHealth Medicare |
$88.40
|
| Rate for Payer: Fidelis Medicare |
$99.09
|
| Rate for Payer: Galaxy Health Commercial |
$169.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$96.20
|
| Rate for Payer: Humana Medicare |
$96.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$156.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$119.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$195.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$146.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$101.01
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$390.00
|
| Rate for Payer: United Healthcare Commercial |
$390.00
|
| Rate for Payer: United Healthcare Medicare |
$96.20
|
| Rate for Payer: WellCare Medicare |
$143.00
|
|
|
X-RAY EXAM OF RIBS 3 VIEWS BILAT
|
Facility
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 71110
|
| Hospital Charge Code |
4150159
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$25.25 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna of NY Commercial |
$189.00
|
| Rate for Payer: Aetna of NY Medicare |
$144.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$116.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$157.50
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: CDPHP Commercial |
$253.58
|
| Rate for Payer: CDPHP Medicare |
$116.55
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$252.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$252.00
|
| Rate for Payer: EmblemHealth Medicaid |
$252.00
|
| Rate for Payer: EmblemHealth Medicare |
$107.10
|
| Rate for Payer: Fidelis Medicare |
$120.05
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$116.55
|
| Rate for Payer: Humana Medicare |
$116.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$189.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$144.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$236.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$177.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$122.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$390.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$25.25
|
| Rate for Payer: United Healthcare Commercial |
$390.00
|
| Rate for Payer: United Healthcare Medicare |
$116.55
|
| Rate for Payer: WellCare Medicare |
$173.25
|
|
|
X-RAY EXAM OF RIBS/CHEST 3+ VIEWS UNILAT
|
Facility
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 71101 TC
|
| Hospital Charge Code |
4150192
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$107.10 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna of NY Commercial |
$189.00
|
| Rate for Payer: Aetna of NY Medicare |
$144.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$116.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$157.50
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: CDPHP Commercial |
$253.58
|
| Rate for Payer: CDPHP Medicare |
$116.55
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$252.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$252.00
|
| Rate for Payer: EmblemHealth Medicaid |
$252.00
|
| Rate for Payer: EmblemHealth Medicare |
$107.10
|
| Rate for Payer: Fidelis Medicare |
$120.05
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$116.55
|
| Rate for Payer: Humana Medicare |
$116.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$189.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$144.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$236.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$177.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$122.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$390.00
|
| Rate for Payer: United Healthcare Commercial |
$390.00
|
| Rate for Payer: United Healthcare Medicare |
$116.55
|
| Rate for Payer: WellCare Medicare |
$173.25
|
|
|
X-RAY EXAM OF RIBS/CHEST 4+ VIEWS BILAT
|
Facility
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 71111
|
| Hospital Charge Code |
4150193
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$27.78 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna of NY Commercial |
$189.00
|
| Rate for Payer: Aetna of NY Medicare |
$144.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$116.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$157.50
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: CDPHP Commercial |
$253.58
|
| Rate for Payer: CDPHP Medicare |
$116.55
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$252.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$252.00
|
| Rate for Payer: EmblemHealth Medicaid |
$252.00
|
| Rate for Payer: EmblemHealth Medicare |
$107.10
|
| Rate for Payer: Fidelis Medicare |
$120.05
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$116.55
|
| Rate for Payer: Humana Medicare |
$116.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$189.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$144.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$236.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$177.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$122.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$390.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$27.78
|
| Rate for Payer: United Healthcare Commercial |
$390.00
|
| Rate for Payer: United Healthcare Medicare |
$116.55
|
| Rate for Payer: WellCare Medicare |
$173.25
|
|
|
X-RAY EXAM OF SCAPULA, LEFT
|
Facility
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 73010 LT
|
| Hospital Charge Code |
4150116
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$107.10 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna of NY Commercial |
$189.00
|
| Rate for Payer: Aetna of NY Medicare |
$144.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$116.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$157.50
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: CDPHP Commercial |
$253.58
|
| Rate for Payer: CDPHP Medicare |
$116.55
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$252.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$252.00
|
| Rate for Payer: EmblemHealth Medicaid |
$252.00
|
| Rate for Payer: EmblemHealth Medicare |
$107.10
|
| Rate for Payer: Fidelis Medicare |
$120.05
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$116.55
|
| Rate for Payer: Humana Medicare |
$116.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$189.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$144.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$236.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$177.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$122.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$390.00
|
| Rate for Payer: United Healthcare Commercial |
$390.00
|
| Rate for Payer: United Healthcare Medicare |
$116.55
|
| Rate for Payer: WellCare Medicare |
$173.25
|
|
|
X-RAY EXAM OF SCAPULA, RIGHT
|
Facility
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 73010 RT
|
| Hospital Charge Code |
4150164
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$107.10 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna of NY Commercial |
$189.00
|
| Rate for Payer: Aetna of NY Medicare |
$144.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$116.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$157.50
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: CDPHP Commercial |
$253.58
|
| Rate for Payer: CDPHP Medicare |
$116.55
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$252.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$252.00
|
| Rate for Payer: EmblemHealth Medicaid |
$252.00
|
| Rate for Payer: EmblemHealth Medicare |
$107.10
|
| Rate for Payer: Fidelis Medicare |
$120.05
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$116.55
|
| Rate for Payer: Humana Medicare |
$116.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$189.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$144.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$236.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$177.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$122.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$390.00
|
| Rate for Payer: United Healthcare Commercial |
$390.00
|
| Rate for Payer: United Healthcare Medicare |
$116.55
|
| Rate for Payer: WellCare Medicare |
$173.25
|
|
|
X-RAY EXAM OF SHOULDER 1 VIEW, BILAT
|
Facility
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 73020 TC
|
| Hospital Charge Code |
4150236
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna of NY Commercial |
$156.00
|
| Rate for Payer: Aetna of NY Medicare |
$119.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$96.20
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$130.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: CDPHP Commercial |
$209.30
|
| Rate for Payer: CDPHP Medicare |
$96.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$208.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$208.00
|
| Rate for Payer: EmblemHealth Medicaid |
$208.00
|
| Rate for Payer: EmblemHealth Medicare |
$88.40
|
| Rate for Payer: Fidelis Medicare |
$99.09
|
| Rate for Payer: Galaxy Health Commercial |
$169.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$96.20
|
| Rate for Payer: Humana Medicare |
$96.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$156.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$119.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$195.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$146.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$101.01
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$390.00
|
| Rate for Payer: United Healthcare Commercial |
$390.00
|
| Rate for Payer: United Healthcare Medicare |
$96.20
|
| Rate for Payer: WellCare Medicare |
$143.00
|
|
|
X-RAY EXAM OF SHOULDER 1 VIEW, LEFT
|
Facility
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 73020 TC,LT
|
| Hospital Charge Code |
4150526
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna of NY Commercial |
$156.00
|
| Rate for Payer: Aetna of NY Medicare |
$119.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$96.20
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$130.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: CDPHP Commercial |
$209.30
|
| Rate for Payer: CDPHP Medicare |
$96.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$208.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$208.00
|
| Rate for Payer: EmblemHealth Medicaid |
$208.00
|
| Rate for Payer: EmblemHealth Medicare |
$88.40
|
| Rate for Payer: Fidelis Medicare |
$99.09
|
| Rate for Payer: Galaxy Health Commercial |
$169.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$96.20
|
| Rate for Payer: Humana Medicare |
$96.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$156.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$119.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$195.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$146.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$101.01
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$390.00
|
| Rate for Payer: United Healthcare Commercial |
$390.00
|
| Rate for Payer: United Healthcare Medicare |
$96.20
|
| Rate for Payer: WellCare Medicare |
$143.00
|
|
|
X-RAY EXAM OF SHOULDER 1 VIEW, RIGHT
|
Facility
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 73020 TC,RT
|
| Hospital Charge Code |
4150235
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna of NY Commercial |
$156.00
|
| Rate for Payer: Aetna of NY Medicare |
$119.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$96.20
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$130.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: CDPHP Commercial |
$209.30
|
| Rate for Payer: CDPHP Medicare |
$96.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$208.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$208.00
|
| Rate for Payer: EmblemHealth Medicaid |
$208.00
|
| Rate for Payer: EmblemHealth Medicare |
$88.40
|
| Rate for Payer: Fidelis Medicare |
$99.09
|
| Rate for Payer: Galaxy Health Commercial |
$169.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$96.20
|
| Rate for Payer: Humana Medicare |
$96.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$156.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$119.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$195.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$146.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$101.01
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$390.00
|
| Rate for Payer: United Healthcare Commercial |
$390.00
|
| Rate for Payer: United Healthcare Medicare |
$96.20
|
| Rate for Payer: WellCare Medicare |
$143.00
|
|
|
X-RAY EXAM OF SHOULDER 2+ VIEWS
|
Facility
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 73030 TC
|
| Hospital Charge Code |
4150225
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna of NY Commercial |
$156.00
|
| Rate for Payer: Aetna of NY Medicare |
$119.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$96.20
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$130.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: CDPHP Commercial |
$209.30
|
| Rate for Payer: CDPHP Medicare |
$96.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$208.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$208.00
|
| Rate for Payer: EmblemHealth Medicaid |
$208.00
|
| Rate for Payer: EmblemHealth Medicare |
$88.40
|
| Rate for Payer: Fidelis Medicare |
$99.09
|
| Rate for Payer: Galaxy Health Commercial |
$169.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$96.20
|
| Rate for Payer: Humana Medicare |
$96.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$156.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$119.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$195.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$146.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$101.01
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$390.00
|
| Rate for Payer: United Healthcare Commercial |
$390.00
|
| Rate for Payer: United Healthcare Medicare |
$96.20
|
| Rate for Payer: WellCare Medicare |
$143.00
|
|
|
X-RAY EXAM OF SHOULDER 2+ VIEWS, LEFT SIDE
|
Facility
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 73030 TC,LT
|
| Hospital Charge Code |
4150120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna of NY Commercial |
$156.00
|
| Rate for Payer: Aetna of NY Medicare |
$119.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$96.20
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$130.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: CDPHP Commercial |
$209.30
|
| Rate for Payer: CDPHP Medicare |
$96.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$208.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$208.00
|
| Rate for Payer: EmblemHealth Medicaid |
$208.00
|
| Rate for Payer: EmblemHealth Medicare |
$88.40
|
| Rate for Payer: Fidelis Medicare |
$99.09
|
| Rate for Payer: Galaxy Health Commercial |
$169.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$96.20
|
| Rate for Payer: Humana Medicare |
$96.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$156.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$119.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$195.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$146.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$101.01
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$390.00
|
| Rate for Payer: United Healthcare Commercial |
$390.00
|
| Rate for Payer: United Healthcare Medicare |
$96.20
|
| Rate for Payer: WellCare Medicare |
$143.00
|
|
|
X-RAY EXAM OF SHOULDER 2+ VIEWS, RIGHT SIDE
|
Facility
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 73030 TC,RT
|
| Hospital Charge Code |
4150169
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna of NY Commercial |
$156.00
|
| Rate for Payer: Aetna of NY Medicare |
$119.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$96.20
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$130.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: CDPHP Commercial |
$209.30
|
| Rate for Payer: CDPHP Medicare |
$96.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$208.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$208.00
|
| Rate for Payer: EmblemHealth Medicaid |
$208.00
|
| Rate for Payer: EmblemHealth Medicare |
$88.40
|
| Rate for Payer: Fidelis Medicare |
$99.09
|
| Rate for Payer: Galaxy Health Commercial |
$169.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$96.20
|
| Rate for Payer: Humana Medicare |
$96.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$156.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$119.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$195.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$146.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$101.01
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$390.00
|
| Rate for Payer: United Healthcare Commercial |
$390.00
|
| Rate for Payer: United Healthcare Medicare |
$96.20
|
| Rate for Payer: WellCare Medicare |
$143.00
|
|
|
X-RAY EXAM OF SINUSES <3 VIEWS
|
Facility
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 70210 TC
|
| Hospital Charge Code |
4150172
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna of NY Commercial |
$156.00
|
| Rate for Payer: Aetna of NY Medicare |
$119.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$96.20
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$130.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: CDPHP Commercial |
$209.30
|
| Rate for Payer: CDPHP Medicare |
$96.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$208.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$208.00
|
| Rate for Payer: EmblemHealth Medicaid |
$208.00
|
| Rate for Payer: EmblemHealth Medicare |
$88.40
|
| Rate for Payer: Fidelis Medicare |
$99.09
|
| Rate for Payer: Galaxy Health Commercial |
$169.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$96.20
|
| Rate for Payer: Humana Medicare |
$96.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$156.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$119.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$195.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$146.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$101.01
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$390.00
|
| Rate for Payer: United Healthcare Commercial |
$390.00
|
| Rate for Payer: United Healthcare Medicare |
$96.20
|
| Rate for Payer: WellCare Medicare |
$143.00
|
|
|
X-RAY EXAM OF SINUSES 3+ VIEWS
|
Facility
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 70220 TC
|
| Hospital Charge Code |
4150510
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna of NY Commercial |
$156.00
|
| Rate for Payer: Aetna of NY Medicare |
$119.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$96.20
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$130.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: CDPHP Commercial |
$209.30
|
| Rate for Payer: CDPHP Medicare |
$96.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$208.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$208.00
|
| Rate for Payer: EmblemHealth Medicaid |
$208.00
|
| Rate for Payer: EmblemHealth Medicare |
$88.40
|
| Rate for Payer: Fidelis Medicare |
$99.09
|
| Rate for Payer: Galaxy Health Commercial |
$169.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$96.20
|
| Rate for Payer: Humana Medicare |
$96.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$156.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$119.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$195.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$146.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$101.01
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$390.00
|
| Rate for Payer: United Healthcare Commercial |
$390.00
|
| Rate for Payer: United Healthcare Medicare |
$96.20
|
| Rate for Payer: WellCare Medicare |
$143.00
|
|
|
X-RAY EXAM OF SKULL <4 VIEWS
|
Facility
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 70250 TC
|
| Hospital Charge Code |
4150174
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$107.10 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna of NY Commercial |
$189.00
|
| Rate for Payer: Aetna of NY Medicare |
$144.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$116.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$157.50
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: CDPHP Commercial |
$253.58
|
| Rate for Payer: CDPHP Medicare |
$116.55
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$252.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$252.00
|
| Rate for Payer: EmblemHealth Medicaid |
$252.00
|
| Rate for Payer: EmblemHealth Medicare |
$107.10
|
| Rate for Payer: Fidelis Medicare |
$120.05
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$116.55
|
| Rate for Payer: Humana Medicare |
$116.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$189.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$144.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$236.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$177.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$122.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$390.00
|
| Rate for Payer: United Healthcare Commercial |
$390.00
|
| Rate for Payer: United Healthcare Medicare |
$116.55
|
| Rate for Payer: WellCare Medicare |
$173.25
|
|
|
X-RAY EXAM OF SKULL 4+ VIEWS
|
Facility
OP
|
$441.00
|
|
|
Service Code
|
HCPCS 70260
|
| Hospital Charge Code |
4150194
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$25.25 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna of NY Commercial |
$264.60
|
| Rate for Payer: Aetna of NY Medicare |
$202.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$330.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$330.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$163.17
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$220.50
|
| Rate for Payer: Cash Price |
$330.75
|
| Rate for Payer: Cash Price |
$330.75
|
| Rate for Payer: CDPHP Commercial |
$355.00
|
| Rate for Payer: CDPHP Medicare |
$163.17
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$352.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$352.80
|
| Rate for Payer: EmblemHealth Medicaid |
$352.80
|
| Rate for Payer: EmblemHealth Medicare |
$149.94
|
| Rate for Payer: Fidelis Medicare |
$168.07
|
| Rate for Payer: Galaxy Health Commercial |
$286.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$163.17
|
| Rate for Payer: Humana Medicare |
$163.17
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$264.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$202.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$330.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$248.28
|
| Rate for Payer: MVP Health Care of NY Medicare |
$171.33
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$390.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$25.25
|
| Rate for Payer: United Healthcare Commercial |
$390.00
|
| Rate for Payer: United Healthcare Medicare |
$163.17
|
| Rate for Payer: WellCare Medicare |
$242.55
|
|
|
X-RAY EXAM OF SPINE 1 VIEW
|
Facility
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 72020 TC
|
| Hospital Charge Code |
4150339
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna of NY Commercial |
$156.00
|
| Rate for Payer: Aetna of NY Medicare |
$119.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$96.20
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$130.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: CDPHP Commercial |
$209.30
|
| Rate for Payer: CDPHP Medicare |
$96.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$208.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$208.00
|
| Rate for Payer: EmblemHealth Medicaid |
$208.00
|
| Rate for Payer: EmblemHealth Medicare |
$88.40
|
| Rate for Payer: Fidelis Medicare |
$99.09
|
| Rate for Payer: Galaxy Health Commercial |
$169.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$96.20
|
| Rate for Payer: Humana Medicare |
$96.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$156.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$119.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$195.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$146.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$101.01
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$390.00
|
| Rate for Payer: United Healthcare Commercial |
$390.00
|
| Rate for Payer: United Healthcare Medicare |
$96.20
|
| Rate for Payer: WellCare Medicare |
$143.00
|
|
|
X-RAY EXAM OF TAILBONE 2+ VIEWS
|
Facility
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 72220
|
| Hospital Charge Code |
4150162
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.15 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna of NY Commercial |
$156.00
|
| Rate for Payer: Aetna of NY Medicare |
$119.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$96.20
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$130.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: CDPHP Commercial |
$209.30
|
| Rate for Payer: CDPHP Medicare |
$96.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$208.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$208.00
|
| Rate for Payer: EmblemHealth Medicaid |
$208.00
|
| Rate for Payer: EmblemHealth Medicare |
$88.40
|
| Rate for Payer: Fidelis Medicare |
$99.09
|
| Rate for Payer: Galaxy Health Commercial |
$169.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$96.20
|
| Rate for Payer: Humana Medicare |
$96.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$156.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$119.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$195.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$146.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$101.01
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$390.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$15.15
|
| Rate for Payer: United Healthcare Commercial |
$390.00
|
| Rate for Payer: United Healthcare Medicare |
$96.20
|
| Rate for Payer: WellCare Medicare |
$143.00
|
|
|
X-RAY EXAM OF TEMPOROMANDIBULAR JOINT, BILAT
|
Facility
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 70330
|
| Hospital Charge Code |
4150180
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.20 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna of NY Commercial |
$156.00
|
| Rate for Payer: Aetna of NY Medicare |
$119.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$96.20
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$130.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: CDPHP Commercial |
$209.30
|
| Rate for Payer: CDPHP Medicare |
$96.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$208.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$208.00
|
| Rate for Payer: EmblemHealth Medicaid |
$208.00
|
| Rate for Payer: EmblemHealth Medicare |
$88.40
|
| Rate for Payer: Fidelis Medicare |
$99.09
|
| Rate for Payer: Galaxy Health Commercial |
$169.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$96.20
|
| Rate for Payer: Humana Medicare |
$96.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$156.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$119.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$195.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$146.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$101.01
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$390.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$20.20
|
| Rate for Payer: United Healthcare Commercial |
$390.00
|
| Rate for Payer: United Healthcare Medicare |
$96.20
|
| Rate for Payer: WellCare Medicare |
$143.00
|
|
|
X-RAY EXAM OF TEMPOROMANDIBULAR JOINT, UNILAT
|
Facility
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 70328
|
| Hospital Charge Code |
4150181
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$12.63 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna of NY Commercial |
$156.00
|
| Rate for Payer: Aetna of NY Medicare |
$119.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$96.20
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$130.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: CDPHP Commercial |
$209.30
|
| Rate for Payer: CDPHP Medicare |
$96.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$208.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$208.00
|
| Rate for Payer: EmblemHealth Medicaid |
$208.00
|
| Rate for Payer: EmblemHealth Medicare |
$88.40
|
| Rate for Payer: Fidelis Medicare |
$99.09
|
| Rate for Payer: Galaxy Health Commercial |
$169.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$96.20
|
| Rate for Payer: Humana Medicare |
$96.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$156.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$119.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$195.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$146.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$101.01
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$390.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$12.63
|
| Rate for Payer: United Healthcare Commercial |
$390.00
|
| Rate for Payer: United Healthcare Medicare |
$96.20
|
| Rate for Payer: WellCare Medicare |
$143.00
|
|
|
X-RAY EXAM OF THORACIC SPINE 2 VIEWS
|
Facility
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 72070
|
| Hospital Charge Code |
4150222
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.15 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna of NY Commercial |
$189.00
|
| Rate for Payer: Aetna of NY Medicare |
$144.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$116.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$157.50
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: CDPHP Commercial |
$253.58
|
| Rate for Payer: CDPHP Medicare |
$116.55
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$252.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$252.00
|
| Rate for Payer: EmblemHealth Medicaid |
$252.00
|
| Rate for Payer: EmblemHealth Medicare |
$107.10
|
| Rate for Payer: Fidelis Medicare |
$120.05
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$116.55
|
| Rate for Payer: Humana Medicare |
$116.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$189.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$144.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$236.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$177.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$122.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$390.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$15.15
|
| Rate for Payer: United Healthcare Commercial |
$390.00
|
| Rate for Payer: United Healthcare Medicare |
$116.55
|
| Rate for Payer: WellCare Medicare |
$173.25
|
|
|
X-RAY EXAM OF THORACIC SPINE 3 VIEWS
|
Facility
OP
|
$502.00
|
|
|
Service Code
|
HCPCS 72072
|
| Hospital Charge Code |
4150256
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$30.30 |
| Max. Negotiated Rate |
$404.11 |
| Rate for Payer: Aetna of NY Commercial |
$301.20
|
| Rate for Payer: Aetna of NY Medicare |
$230.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$376.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$376.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$185.74
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$251.00
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: CDPHP Commercial |
$404.11
|
| Rate for Payer: CDPHP Medicare |
$185.74
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$401.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$401.60
|
| Rate for Payer: EmblemHealth Medicaid |
$401.60
|
| Rate for Payer: EmblemHealth Medicare |
$170.68
|
| Rate for Payer: Fidelis Medicare |
$191.31
|
| Rate for Payer: Galaxy Health Commercial |
$326.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$185.74
|
| Rate for Payer: Humana Medicare |
$185.74
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$301.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$230.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$376.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$282.63
|
| Rate for Payer: MVP Health Care of NY Medicare |
$195.03
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$390.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$30.30
|
| Rate for Payer: United Healthcare Commercial |
$390.00
|
| Rate for Payer: United Healthcare Medicare |
$185.74
|
| Rate for Payer: WellCare Medicare |
$276.10
|
|
|
X-RAY EXAM OF THORACIC SPINE 4+ VIEWS
|
Facility
OP
|
$502.00
|
|
|
Service Code
|
HCPCS 72074
|
| Hospital Charge Code |
4150258
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$30.30 |
| Max. Negotiated Rate |
$404.11 |
| Rate for Payer: Aetna of NY Commercial |
$301.20
|
| Rate for Payer: Aetna of NY Medicare |
$230.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$376.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$376.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$185.74
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$251.00
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: CDPHP Commercial |
$404.11
|
| Rate for Payer: CDPHP Medicare |
$185.74
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$401.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$401.60
|
| Rate for Payer: EmblemHealth Medicaid |
$401.60
|
| Rate for Payer: EmblemHealth Medicare |
$170.68
|
| Rate for Payer: Fidelis Medicare |
$191.31
|
| Rate for Payer: Galaxy Health Commercial |
$326.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$185.74
|
| Rate for Payer: Humana Medicare |
$185.74
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$301.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$230.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$376.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$282.63
|
| Rate for Payer: MVP Health Care of NY Medicare |
$195.03
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$390.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$30.30
|
| Rate for Payer: United Healthcare Commercial |
$390.00
|
| Rate for Payer: United Healthcare Medicare |
$185.74
|
| Rate for Payer: WellCare Medicare |
$276.10
|
|
