|
X-RAY BONE SURVEY INFANT
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
HCPCS 77076
|
| Hospital Charge Code |
4150522
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$402.00 |
| Rate for Payer: Aetna of NY Commercial |
$192.00
|
| Rate for Payer: Aetna of NY Medicare |
$147.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$128.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: CDPHP Medicare |
$118.40
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$224.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$256.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$256.00
|
| Rate for Payer: EmblemHealth Medicaid |
$256.00
|
| Rate for Payer: EmblemHealth Medicare |
$108.80
|
| Rate for Payer: EmblemHealth Select Care |
$208.00
|
| Rate for Payer: Fidelis Medicare |
$128.00
|
| Rate for Payer: Galaxy Health Commercial |
$208.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$128.00
|
| Rate for Payer: Humana Medicare |
$128.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$192.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$147.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$240.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$180.16
|
| Rate for Payer: MVP Health Care of NY Medicare |
$134.40
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$402.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$48.00
|
| Rate for Payer: United Healthcare Commercial |
$402.00
|
| Rate for Payer: United Healthcare Medicare |
$128.00
|
| Rate for Payer: WellCare Medicare |
$176.00
|
|
|
X-RAY BONE SURVEY INFANT
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
HCPCS 77076 26
|
| Hospital Charge Code |
5150522
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$67.60 |
| Max. Negotiated Rate |
$67.60 |
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Galaxy Health Commercial |
$67.60
|
|
|
X-RAY BONE SURVEY INFANT
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
HCPCS 77076
|
| Hospital Charge Code |
4150522
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Galaxy Health Commercial |
$208.00
|
|
|
X-RAY BONE SURVEY LIMITED
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
HCPCS 77074
|
| Hospital Charge Code |
4150324
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$402.00 |
| Rate for Payer: Aetna of NY Commercial |
$192.00
|
| Rate for Payer: Aetna of NY Medicare |
$147.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$128.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: CDPHP Medicare |
$118.40
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$224.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$256.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$256.00
|
| Rate for Payer: EmblemHealth Medicaid |
$256.00
|
| Rate for Payer: EmblemHealth Medicare |
$108.80
|
| Rate for Payer: EmblemHealth Select Care |
$208.00
|
| Rate for Payer: Fidelis Medicare |
$128.00
|
| Rate for Payer: Galaxy Health Commercial |
$208.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$128.00
|
| Rate for Payer: Humana Medicare |
$128.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$192.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$147.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$240.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$180.16
|
| Rate for Payer: MVP Health Care of NY Medicare |
$134.40
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$402.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$48.00
|
| Rate for Payer: United Healthcare Commercial |
$402.00
|
| Rate for Payer: United Healthcare Medicare |
$128.00
|
| Rate for Payer: WellCare Medicare |
$176.00
|
|
|
X-RAY BONE SURVEY LIMITED
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 77074 26
|
| Hospital Charge Code |
5150324
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$52.00 |
| Rate for Payer: Aetna of NY Commercial |
$45.50
|
| Rate for Payer: Aetna of NY Medicare |
$29.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$26.00
|
| Rate for Payer: Cash Price |
$48.75
|
| Rate for Payer: CDPHP Medicare |
$24.05
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$52.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$52.00
|
| Rate for Payer: EmblemHealth Medicaid |
$52.00
|
| Rate for Payer: EmblemHealth Medicare |
$22.10
|
| Rate for Payer: Fidelis Medicare |
$26.00
|
| Rate for Payer: Galaxy Health Commercial |
$42.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$26.00
|
| Rate for Payer: Humana Medicare |
$26.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$45.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$29.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$48.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$36.59
|
| Rate for Payer: MVP Health Care of NY Medicare |
$27.30
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.75
|
| Rate for Payer: United Healthcare Medicare |
$26.00
|
| Rate for Payer: WellCare Medicare |
$35.75
|
|
|
X-RAY BONE SURVEY LIMITED
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
HCPCS 77074
|
| Hospital Charge Code |
4150324
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Galaxy Health Commercial |
$208.00
|
|
|
X-RAY BONE SURVEY LIMITED
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 77074 26
|
| Hospital Charge Code |
5150324
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$42.25 |
| Max. Negotiated Rate |
$42.25 |
| Rate for Payer: Cash Price |
$48.75
|
| Rate for Payer: Galaxy Health Commercial |
$42.25
|
|
|
X-RAY EXAM ABDOMEN 1 VIEW
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
HCPCS 74018 TC
|
| Hospital Charge Code |
4150507
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$173.55 |
| Max. Negotiated Rate |
$173.55 |
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Galaxy Health Commercial |
$173.55
|
|
|
X-RAY EXAM ABDOMEN 1 VIEW
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
HCPCS 74018 TC
|
| Hospital Charge Code |
4150507
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.05 |
| Max. Negotiated Rate |
$402.00 |
| Rate for Payer: Aetna of NY Commercial |
$160.20
|
| Rate for Payer: Aetna of NY Medicare |
$122.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$106.80
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: CDPHP Medicare |
$98.79
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$186.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$213.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$213.60
|
| Rate for Payer: EmblemHealth Medicaid |
$213.60
|
| Rate for Payer: EmblemHealth Medicare |
$90.78
|
| Rate for Payer: EmblemHealth Select Care |
$173.55
|
| Rate for Payer: Fidelis Medicare |
$106.80
|
| Rate for Payer: Galaxy Health Commercial |
$173.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$106.80
|
| Rate for Payer: Humana Medicare |
$106.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$160.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$122.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$200.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$150.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$112.14
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$402.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$40.05
|
| Rate for Payer: United Healthcare Commercial |
$402.00
|
| Rate for Payer: United Healthcare Medicare |
$106.80
|
| Rate for Payer: WellCare Medicare |
$146.85
|
|
|
X-RAY EXAM ABDOMEN, 1 VIEW
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
HCPCS 74018 26
|
| Hospital Charge Code |
5150507
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna of NY Commercial |
$18.90
|
| Rate for Payer: Aetna of NY Medicare |
$12.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$10.80
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: CDPHP Medicare |
$9.99
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$21.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$21.60
|
| Rate for Payer: EmblemHealth Medicaid |
$21.60
|
| Rate for Payer: EmblemHealth Medicare |
$9.18
|
| Rate for Payer: Fidelis Medicare |
$10.80
|
| Rate for Payer: Galaxy Health Commercial |
$17.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$10.80
|
| Rate for Payer: Humana Medicare |
$10.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$18.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$12.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$15.20
|
| Rate for Payer: MVP Health Care of NY Medicare |
$11.34
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.05
|
| Rate for Payer: United Healthcare Medicare |
$10.80
|
| Rate for Payer: WellCare Medicare |
$14.85
|
|
|
X-RAY EXAM ABDOMEN, 1 VIEW
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
HCPCS 74018 26
|
| Hospital Charge Code |
5150507
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$17.55 |
| Max. Negotiated Rate |
$17.55 |
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Galaxy Health Commercial |
$17.55
|
|
|
X-RAY EXAM ABDOMEN 2 VIEWS
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
HCPCS 74019
|
| Hospital Charge Code |
4150508
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$402.00 |
| Rate for Payer: Aetna of NY Commercial |
$192.00
|
| Rate for Payer: Aetna of NY Medicare |
$147.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$128.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: CDPHP Medicare |
$118.40
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$224.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$256.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$256.00
|
| Rate for Payer: EmblemHealth Medicaid |
$256.00
|
| Rate for Payer: EmblemHealth Medicare |
$108.80
|
| Rate for Payer: EmblemHealth Select Care |
$208.00
|
| Rate for Payer: Fidelis Medicare |
$128.00
|
| Rate for Payer: Galaxy Health Commercial |
$208.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$128.00
|
| Rate for Payer: Humana Medicare |
$128.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$192.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$147.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$240.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$180.16
|
| Rate for Payer: MVP Health Care of NY Medicare |
$134.40
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$402.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$48.00
|
| Rate for Payer: United Healthcare Commercial |
$402.00
|
| Rate for Payer: United Healthcare Medicare |
$128.00
|
| Rate for Payer: WellCare Medicare |
$176.00
|
|
|
X-RAY EXAM ABDOMEN 2 VIEWS
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
HCPCS 74019
|
| Hospital Charge Code |
4150508
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Galaxy Health Commercial |
$208.00
|
|
|
X-RAY EXAM ABDOMEN, 2 VIEWS
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
HCPCS 74019 26
|
| Hospital Charge Code |
5150508
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Aetna of NY Commercial |
$24.50
|
| Rate for Payer: Aetna of NY Medicare |
$16.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.00
|
| Rate for Payer: Cash Price |
$26.25
|
| Rate for Payer: CDPHP Medicare |
$12.95
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$28.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$28.00
|
| Rate for Payer: EmblemHealth Medicaid |
$28.00
|
| Rate for Payer: EmblemHealth Medicare |
$11.90
|
| Rate for Payer: Fidelis Medicare |
$14.00
|
| Rate for Payer: Galaxy Health Commercial |
$22.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.00
|
| Rate for Payer: Humana Medicare |
$14.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$24.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$16.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$26.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$19.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.70
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.25
|
| Rate for Payer: United Healthcare Medicare |
$14.00
|
| Rate for Payer: WellCare Medicare |
$19.25
|
|
|
X-RAY EXAM ABDOMEN, 2 VIEWS
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
HCPCS 74019 26
|
| Hospital Charge Code |
5150508
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$22.75 |
| Rate for Payer: Cash Price |
$26.25
|
| Rate for Payer: Galaxy Health Commercial |
$22.75
|
|
|
X-RAY EXAM ABDOMEN 3+ VIEWS
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
HCPCS 74021
|
| Hospital Charge Code |
4150509
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Galaxy Health Commercial |
$208.00
|
|
|
X-RAY EXAM ABDOMEN 3+ VIEWS
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
HCPCS 74021
|
| Hospital Charge Code |
4150509
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$402.00 |
| Rate for Payer: Aetna of NY Commercial |
$192.00
|
| Rate for Payer: Aetna of NY Medicare |
$147.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$128.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: CDPHP Medicare |
$118.40
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$224.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$256.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$256.00
|
| Rate for Payer: EmblemHealth Medicaid |
$256.00
|
| Rate for Payer: EmblemHealth Medicare |
$108.80
|
| Rate for Payer: EmblemHealth Select Care |
$208.00
|
| Rate for Payer: Fidelis Medicare |
$128.00
|
| Rate for Payer: Galaxy Health Commercial |
$208.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$128.00
|
| Rate for Payer: Humana Medicare |
$128.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$192.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$147.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$240.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$180.16
|
| Rate for Payer: MVP Health Care of NY Medicare |
$134.40
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$402.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$48.00
|
| Rate for Payer: United Healthcare Commercial |
$402.00
|
| Rate for Payer: United Healthcare Medicare |
$128.00
|
| Rate for Payer: WellCare Medicare |
$176.00
|
|
|
X-RAY EXAM ABDOMEN, 3+ VIEWS
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS 74021 26
|
| Hospital Charge Code |
5150509
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Galaxy Health Commercial |
$26.00
|
|
|
X-RAY EXAM ABDOMEN, 3+ VIEWS
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS 74021 26
|
| Hospital Charge Code |
5150509
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: Aetna of NY Commercial |
$28.00
|
| Rate for Payer: Aetna of NY Medicare |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: CDPHP Medicare |
$14.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$32.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$32.00
|
| Rate for Payer: EmblemHealth Medicaid |
$32.00
|
| Rate for Payer: EmblemHealth Medicare |
$13.60
|
| Rate for Payer: Fidelis Medicare |
$16.00
|
| Rate for Payer: Galaxy Health Commercial |
$26.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.00
|
| Rate for Payer: Humana Medicare |
$16.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$28.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$18.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$22.52
|
| Rate for Payer: MVP Health Care of NY Medicare |
$16.80
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.00
|
| Rate for Payer: United Healthcare Medicare |
$16.00
|
| Rate for Payer: WellCare Medicare |
$22.00
|
|
|
X-RAY EXAM CHEST 1 VIEW
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
HCPCS 71045 TC
|
| Hospital Charge Code |
4150503
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$173.55 |
| Max. Negotiated Rate |
$173.55 |
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Galaxy Health Commercial |
$173.55
|
|
|
X-RAY EXAM CHEST 1 VIEW
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
HCPCS 71045 TC
|
| Hospital Charge Code |
4150503
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$40.05 |
| Max. Negotiated Rate |
$402.00 |
| Rate for Payer: Aetna of NY Commercial |
$160.20
|
| Rate for Payer: Aetna of NY Medicare |
$122.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$106.80
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: CDPHP Medicare |
$98.79
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$186.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$213.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$213.60
|
| Rate for Payer: EmblemHealth Medicaid |
$213.60
|
| Rate for Payer: EmblemHealth Medicare |
$90.78
|
| Rate for Payer: EmblemHealth Select Care |
$173.55
|
| Rate for Payer: Fidelis Medicare |
$106.80
|
| Rate for Payer: Galaxy Health Commercial |
$173.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$106.80
|
| Rate for Payer: Humana Medicare |
$106.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$160.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$122.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$200.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$150.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$112.14
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$402.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$40.05
|
| Rate for Payer: United Healthcare Commercial |
$402.00
|
| Rate for Payer: United Healthcare Medicare |
$106.80
|
| Rate for Payer: WellCare Medicare |
$146.85
|
|
|
X-RAY EXAM CHEST, 1 VIEW
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
HCPCS 71045 26
|
| Hospital Charge Code |
5150503
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna of NY Commercial |
$18.90
|
| Rate for Payer: Aetna of NY Medicare |
$12.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$10.80
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: CDPHP Medicare |
$9.99
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$21.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$21.60
|
| Rate for Payer: EmblemHealth Medicaid |
$21.60
|
| Rate for Payer: EmblemHealth Medicare |
$9.18
|
| Rate for Payer: Fidelis Medicare |
$10.80
|
| Rate for Payer: Galaxy Health Commercial |
$17.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$10.80
|
| Rate for Payer: Humana Medicare |
$10.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$18.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$12.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$15.20
|
| Rate for Payer: MVP Health Care of NY Medicare |
$11.34
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.05
|
| Rate for Payer: United Healthcare Medicare |
$10.80
|
| Rate for Payer: WellCare Medicare |
$14.85
|
|
|
X-RAY EXAM CHEST, 1 VIEW
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
HCPCS 71045 26
|
| Hospital Charge Code |
5150503
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$17.55 |
| Max. Negotiated Rate |
$17.55 |
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Galaxy Health Commercial |
$17.55
|
|
|
X-RAY EXAM CHEST 2 VIEWS
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
HCPCS 71046 TC
|
| Hospital Charge Code |
4150504
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$173.55 |
| Max. Negotiated Rate |
$173.55 |
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Galaxy Health Commercial |
$173.55
|
|
|
X-RAY EXAM CHEST 2 VIEWS
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
HCPCS 71046 TC
|
| Hospital Charge Code |
4150504
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$40.05 |
| Max. Negotiated Rate |
$402.00 |
| Rate for Payer: Aetna of NY Commercial |
$160.20
|
| Rate for Payer: Aetna of NY Medicare |
$122.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$106.80
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: CDPHP Medicare |
$98.79
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$186.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$213.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$213.60
|
| Rate for Payer: EmblemHealth Medicaid |
$213.60
|
| Rate for Payer: EmblemHealth Medicare |
$90.78
|
| Rate for Payer: EmblemHealth Select Care |
$173.55
|
| Rate for Payer: Fidelis Medicare |
$106.80
|
| Rate for Payer: Galaxy Health Commercial |
$173.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$106.80
|
| Rate for Payer: Humana Medicare |
$106.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$160.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$122.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$200.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$150.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$112.14
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$402.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$40.05
|
| Rate for Payer: United Healthcare Commercial |
$402.00
|
| Rate for Payer: United Healthcare Medicare |
$106.80
|
| Rate for Payer: WellCare Medicare |
$146.85
|
|
