|
X-RAY EXAM OF HUMERUS 2+ VIEWS, RIGHT
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 73060 TC,RT
|
| Hospital Charge Code |
4150082
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$169.00 |
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Galaxy Health Commercial |
$169.00
|
|
|
X-RAY EXAM OF JAW <4 VIEWS
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 70100
|
| Hospital Charge Code |
4150111
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$169.00 |
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Galaxy Health Commercial |
$169.00
|
|
|
X-RAY EXAM OF JAW <4 VIEWS
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 70100
|
| Hospital Charge Code |
4150111
|
|
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 CBP/EPO/PPO/HMO/Network Access |
$182.00
|
| 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: EmblemHealth Select Care |
$169.00
|
| 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 JAW 4+ VIEWS
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 70110
|
| Hospital Charge Code |
4150135
|
|
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 CBP/EPO/PPO/HMO/Network Access |
$220.50
|
| 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: EmblemHealth Select Care |
$204.75
|
| 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 JAW 4+ VIEWS
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 70110
|
| Hospital Charge Code |
4150135
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
|
|
X-RAY EXAM OF KNEE 1 OR 2, LEFT
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 73560
|
| Hospital Charge Code |
4150089
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.10 |
| 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 CBP/EPO/PPO/HMO/Network Access |
$182.00
|
| 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: EmblemHealth Select Care |
$169.00
|
| 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 |
$10.10
|
| 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 KNEE 1 OR 2, LEFT
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 73560
|
| Hospital Charge Code |
4150089
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$169.00 |
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Galaxy Health Commercial |
$169.00
|
|
|
X-RAY EXAM OF KNEE 1 OR 2, RIGHT
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 73560
|
| Hospital Charge Code |
4150091
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.10 |
| 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 CBP/EPO/PPO/HMO/Network Access |
$182.00
|
| 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: EmblemHealth Select Care |
$169.00
|
| 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 |
$10.10
|
| 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 KNEE 1 OR 2, RIGHT
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 73560
|
| Hospital Charge Code |
4150091
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$169.00 |
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Galaxy Health Commercial |
$169.00
|
|
|
X-RAY EXAM OF KNEE 3, LEFT
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 73562 TC,LT
|
| Hospital Charge Code |
4150114
|
|
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 CBP/EPO/PPO/HMO/Network Access |
$182.00
|
| 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: EmblemHealth Select Care |
$169.00
|
| 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 KNEE 3, LEFT
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 73562 TC,LT
|
| Hospital Charge Code |
4150114
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$169.00 |
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Galaxy Health Commercial |
$169.00
|
|
|
X-RAY EXAM OF KNEE 3, RIGHT
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 73562 TC,RT
|
| Hospital Charge Code |
4150092
|
|
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 CBP/EPO/PPO/HMO/Network Access |
$182.00
|
| 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: EmblemHealth Select Care |
$169.00
|
| 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 KNEE 3, RIGHT
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 73562 TC,RT
|
| Hospital Charge Code |
4150092
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$169.00 |
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Galaxy Health Commercial |
$169.00
|
|
|
X-RAY EXAM OF LEG INFANT 2 VIEWS, BILATERAL
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 73592 TC,50
|
| Hospital Charge Code |
4150518
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$169.00 |
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Galaxy Health Commercial |
$169.00
|
|
|
X-RAY EXAM OF LEG INFANT 2 VIEWS, BILATERAL
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 73592 TC,50
|
| Hospital Charge Code |
4150518
|
|
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 CBP/EPO/PPO/HMO/Network Access |
$182.00
|
| 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: EmblemHealth Select Care |
$169.00
|
| 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 LEG INFANT 2 VIEWS, LEFT
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 73592 TC,LT
|
| Hospital Charge Code |
4150519
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$169.00 |
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Galaxy Health Commercial |
$169.00
|
|
|
X-RAY EXAM OF LEG INFANT 2 VIEWS, LEFT
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 73592 TC,LT
|
| Hospital Charge Code |
4150519
|
|
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 CBP/EPO/PPO/HMO/Network Access |
$182.00
|
| 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: EmblemHealth Select Care |
$169.00
|
| 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 LEG INFANT 2 VIEWS, RIGHT
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 73592 TC,RT
|
| Hospital Charge Code |
4150520
|
|
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 CBP/EPO/PPO/HMO/Network Access |
$182.00
|
| 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: EmblemHealth Select Care |
$169.00
|
| 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 LEG INFANT 2 VIEWS, RIGHT
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 73592 TC,RT
|
| Hospital Charge Code |
4150520
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$169.00 |
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Galaxy Health Commercial |
$169.00
|
|
|
X-RAY EXAM OF LOWER LEG 2 VIEWS, LEFT
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 73590 LT
|
| Hospital Charge Code |
4150121
|
|
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 CBP/EPO/PPO/HMO/Network Access |
$182.00
|
| 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: EmblemHealth Select Care |
$169.00
|
| 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 LOWER LEG 2 VIEWS, LEFT
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 73590 LT
|
| Hospital Charge Code |
4150121
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$169.00 |
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Galaxy Health Commercial |
$169.00
|
|
|
X-RAY EXAM OF LOWER LEG 2 VIEWS, RIGHT
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 73590 RT
|
| Hospital Charge Code |
4150183
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$169.00 |
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Galaxy Health Commercial |
$169.00
|
|
|
X-RAY EXAM OF LOWER LEG 2 VIEWS, RIGHT
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 73590 RT
|
| Hospital Charge Code |
4150183
|
|
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 CBP/EPO/PPO/HMO/Network Access |
$182.00
|
| 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: EmblemHealth Select Care |
$169.00
|
| 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 LOWER SPINE
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 72120
|
| Hospital Charge Code |
4150512
|
|
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 CBP/EPO/PPO/HMO/Network Access |
$220.50
|
| 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: EmblemHealth Select Care |
$204.75
|
| 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 LOWER SPINE
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 72114
|
| Hospital Charge Code |
4150099
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
|
