|
X-RAY EXAM OF TOE(S) 2+ VIEWS, LEFT, GREAT TOE
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 73660 TA
|
| Hospital Charge Code |
4150220
|
|
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 TOE(S) 2+ VIEWS, LEFT, SECOND DIGIT
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 73660 TC,T1
|
| Hospital Charge Code |
4150005
|
|
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 TOE(S) 2+ VIEWS, LEFT, SECOND DIGIT
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 73660 TC,T1
|
| Hospital Charge Code |
4150005
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$7.58 |
| 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 |
$7.58
|
| 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 TOE(S) 2+ VIEWS, LEFT, THIRD DIGIT
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 73660 TC,T2
|
| Hospital Charge Code |
4150006
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$7.58 |
| 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 |
$7.58
|
| 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 TOE(S) 2+ VIEWS, LEFT, THIRD DIGIT
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 73660 TC,T2
|
| Hospital Charge Code |
4150006
|
|
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 TOE(S) 2+ VIEWS, RIGHT, FIFTH DIGIT
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 73660 T9
|
| Hospital Charge Code |
4150015
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$7.58 |
| 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 |
$7.58
|
| 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 TOE(S) 2+ VIEWS, RIGHT, FIFTH DIGIT
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 73660 T9
|
| Hospital Charge Code |
4150015
|
|
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 TOE(S) 2+ VIEWS, RIGHT, FOURTH DIGIT
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 73660 T8
|
| Hospital Charge Code |
4150012
|
|
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 TOE(S) 2+ VIEWS, RIGHT, FOURTH DIGIT
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 73660 T8
|
| Hospital Charge Code |
4150012
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$7.58 |
| 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 |
$7.58
|
| 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 TOE(S) 2+ VIEWS, RIGHT, GREAT TOE
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 73660 TC,T5
|
| Hospital Charge Code |
4150009
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$7.58 |
| 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 |
$7.58
|
| 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 TOE(S) 2+ VIEWS, RIGHT, GREAT TOE
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 73660 TC,T5
|
| Hospital Charge Code |
4150009
|
|
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 TOE(S) 2+ VIEWS, RIGHT, SECOND DIGIT
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 73660 T6
|
| Hospital Charge Code |
4150010
|
|
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 TOE(S) 2+ VIEWS, RIGHT, SECOND DIGIT
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 73660 T6
|
| Hospital Charge Code |
4150010
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$7.58 |
| 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 |
$7.58
|
| 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 TOE(S) 2+ VIEWS, RIGHT, THIRD DIGIT
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 73660 T7
|
| Hospital Charge Code |
4150011
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$7.58 |
| 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 |
$7.58
|
| 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 TOE(S) 2+ VIEWS, RIGHT, THIRD DIGIT
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 73660 T7
|
| Hospital Charge Code |
4150011
|
|
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 WRIST 2 VIEWS, BILAT
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 73100 TC,50
|
| Hospital Charge Code |
4150319
|
|
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 WRIST 2 VIEWS, BILAT
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 73100 TC,50
|
| Hospital Charge Code |
4150319
|
|
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 WRIST 2 VIEWS, LEFT
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 73100 TC,LT
|
| Hospital Charge Code |
4150125
|
|
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 WRIST 2 VIEWS, LEFT
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 73100 TC,LT
|
| Hospital Charge Code |
4150125
|
|
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 WRIST 2 VIEWS, RIGHT
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 73100 TC,RT
|
| Hospital Charge Code |
4150216
|
|
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 WRIST 2 VIEWS, RIGHT
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 73100 TC,RT
|
| Hospital Charge Code |
4150216
|
|
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 WRIST 3+ VIEWS, BILAT
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 73110 TC
|
| Hospital Charge Code |
4150318
|
|
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 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 |
$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 WRIST 3+ VIEWS, BILAT
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 73110 TC
|
| Hospital Charge Code |
4150318
|
|
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 WRIST 3+ VIEWS, LEFT
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 73110 TC,LT
|
| Hospital Charge Code |
4150127
|
|
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 WRIST 3+ VIEWS, LEFT
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 73110 TC,LT
|
| Hospital Charge Code |
4150127
|
|
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 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 |
$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
|
|
