|
X-RAY EXAM ENTIRE SPINE,1 VIEW
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
HCPCS 72081 26
|
| Hospital Charge Code |
5150259
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna of NY Commercial |
$27.30
|
| Rate for Payer: Aetna of NY Medicare |
$17.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$15.60
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: CDPHP Medicare |
$14.43
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$31.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$31.20
|
| Rate for Payer: EmblemHealth Medicaid |
$31.20
|
| Rate for Payer: EmblemHealth Medicare |
$13.26
|
| Rate for Payer: Fidelis Medicare |
$15.60
|
| Rate for Payer: Galaxy Health Commercial |
$25.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$15.60
|
| Rate for Payer: Humana Medicare |
$15.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$27.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$29.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$21.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$16.38
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.85
|
| Rate for Payer: United Healthcare Medicare |
$15.60
|
| Rate for Payer: WellCare Medicare |
$21.45
|
|
|
X-RAY EXAM ENTIRE SPINE, 2/3 VIEWS
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
HCPCS 72082 26
|
| Hospital Charge Code |
5150165
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$7.05 |
| Max. Negotiated Rate |
$37.60 |
| Rate for Payer: Aetna of NY Commercial |
$32.90
|
| Rate for Payer: Aetna of NY Medicare |
$21.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.80
|
| Rate for Payer: Cash Price |
$35.25
|
| Rate for Payer: CDPHP Medicare |
$17.39
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$37.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$37.60
|
| Rate for Payer: EmblemHealth Medicaid |
$37.60
|
| Rate for Payer: EmblemHealth Medicare |
$15.98
|
| Rate for Payer: Fidelis Medicare |
$18.80
|
| Rate for Payer: Galaxy Health Commercial |
$30.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.80
|
| Rate for Payer: Humana Medicare |
$18.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$32.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$21.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$35.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$26.46
|
| Rate for Payer: MVP Health Care of NY Medicare |
$19.74
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.05
|
| Rate for Payer: United Healthcare Medicare |
$18.80
|
| Rate for Payer: WellCare Medicare |
$25.85
|
|
|
X-RAY EXAM ENTIRE SPINE, 2/3 VIEWS
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
HCPCS 72082 26
|
| Hospital Charge Code |
5150165
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$30.55 |
| Max. Negotiated Rate |
$30.55 |
| Rate for Payer: Cash Price |
$35.25
|
| Rate for Payer: Galaxy Health Commercial |
$30.55
|
|
|
X-RAY EXAM ENTIRE SPINE, 2/3 VIEWS, LEFT
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS 73020 26,LT
|
| Hospital Charge Code |
5150530
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$14.95 |
| Max. Negotiated Rate |
$14.95 |
| Rate for Payer: Cash Price |
$17.25
|
| Rate for Payer: Galaxy Health Commercial |
$14.95
|
|
|
X-RAY EXAM ENTIRE SPINE, 2/3 VIEWS, LEFT
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS 73020 26,LT
|
| Hospital Charge Code |
5150530
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$18.40 |
| Rate for Payer: Aetna of NY Commercial |
$16.10
|
| Rate for Payer: Aetna of NY Medicare |
$10.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.20
|
| Rate for Payer: Cash Price |
$17.25
|
| Rate for Payer: CDPHP Medicare |
$8.51
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$18.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$18.40
|
| Rate for Payer: EmblemHealth Medicaid |
$18.40
|
| Rate for Payer: EmblemHealth Medicare |
$7.82
|
| Rate for Payer: Fidelis Medicare |
$9.20
|
| Rate for Payer: Galaxy Health Commercial |
$14.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.20
|
| Rate for Payer: Humana Medicare |
$9.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.95
|
| Rate for Payer: MVP Health Care of NY Medicare |
$9.66
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.45
|
| Rate for Payer: United Healthcare Medicare |
$9.20
|
| Rate for Payer: WellCare Medicare |
$12.65
|
|
|
X-RAY EXAM ENTIRE SPINE, 2/3 VIEWS, RIGHT
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS 73020 26,RT
|
| Hospital Charge Code |
5150529
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$18.40 |
| Rate for Payer: Aetna of NY Commercial |
$16.10
|
| Rate for Payer: Aetna of NY Medicare |
$10.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.20
|
| Rate for Payer: Cash Price |
$17.25
|
| Rate for Payer: CDPHP Medicare |
$8.51
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$18.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$18.40
|
| Rate for Payer: EmblemHealth Medicaid |
$18.40
|
| Rate for Payer: EmblemHealth Medicare |
$7.82
|
| Rate for Payer: Fidelis Medicare |
$9.20
|
| Rate for Payer: Galaxy Health Commercial |
$14.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.20
|
| Rate for Payer: Humana Medicare |
$9.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.95
|
| Rate for Payer: MVP Health Care of NY Medicare |
$9.66
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.45
|
| Rate for Payer: United Healthcare Medicare |
$9.20
|
| Rate for Payer: WellCare Medicare |
$12.65
|
|
|
X-RAY EXAM ENTIRE SPINE, 2/3 VIEWS, RIGHT
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS 73020 26,RT
|
| Hospital Charge Code |
5150529
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$14.95 |
| Max. Negotiated Rate |
$14.95 |
| Rate for Payer: Cash Price |
$17.25
|
| Rate for Payer: Galaxy Health Commercial |
$14.95
|
|
|
X-RAY EXAM ENTIRE SPINE, 4/5 VIEWS
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
HCPCS 72083 26
|
| Hospital Charge Code |
5150502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$34.45 |
| Max. Negotiated Rate |
$34.45 |
| Rate for Payer: Cash Price |
$39.75
|
| Rate for Payer: Galaxy Health Commercial |
$34.45
|
|
|
X-RAY EXAM ENTIRE SPINE, 4/5 VIEWS
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
HCPCS 72083 26
|
| Hospital Charge Code |
5150502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$7.95 |
| Max. Negotiated Rate |
$42.40 |
| Rate for Payer: Aetna of NY Commercial |
$37.10
|
| Rate for Payer: Aetna of NY Medicare |
$24.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.20
|
| Rate for Payer: Cash Price |
$39.75
|
| Rate for Payer: CDPHP Medicare |
$19.61
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$42.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$42.40
|
| Rate for Payer: EmblemHealth Medicaid |
$42.40
|
| Rate for Payer: EmblemHealth Medicare |
$18.02
|
| Rate for Payer: Fidelis Medicare |
$21.20
|
| Rate for Payer: Galaxy Health Commercial |
$34.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.20
|
| Rate for Payer: Humana Medicare |
$21.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$37.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$24.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$39.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$29.84
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22.26
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.95
|
| Rate for Payer: United Healthcare Medicare |
$21.20
|
| Rate for Payer: WellCare Medicare |
$29.15
|
|
|
X-RAY EXAM ENTIRE SPINE 6/> VIEWS
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
HCPCS 72084 26
|
| Hospital Charge Code |
5150260
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna of NY Commercial |
$44.10
|
| Rate for Payer: Aetna of NY Medicare |
$28.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$25.20
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: CDPHP Medicare |
$23.31
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$50.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$50.40
|
| Rate for Payer: EmblemHealth Medicaid |
$50.40
|
| Rate for Payer: EmblemHealth Medicare |
$21.42
|
| Rate for Payer: Fidelis Medicare |
$25.20
|
| Rate for Payer: Galaxy Health Commercial |
$40.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$25.20
|
| Rate for Payer: Humana Medicare |
$25.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$44.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$28.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$47.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$35.47
|
| Rate for Payer: MVP Health Care of NY Medicare |
$26.46
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.45
|
| Rate for Payer: United Healthcare Medicare |
$25.20
|
| Rate for Payer: WellCare Medicare |
$34.65
|
|
|
X-RAY EXAM ENTIRE SPINE 6/> VIEWS
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
HCPCS 72084 26
|
| Hospital Charge Code |
5150260
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$40.95 |
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Galaxy Health Commercial |
$40.95
|
|
|
X-RAY EXAM HIPS BI 2 VIEWS
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
HCPCS 73521
|
| Hospital Charge Code |
4150516
|
|
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 HIPS BI 2 VIEWS
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
HCPCS 73521
|
| Hospital Charge Code |
4150516
|
|
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 HIPS, BI, 2 VIEWS
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
HCPCS 73521 26
|
| Hospital Charge Code |
5150516
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$27.20 |
| Rate for Payer: Aetna of NY Commercial |
$23.80
|
| Rate for Payer: Aetna of NY Medicare |
$15.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.60
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: CDPHP Medicare |
$12.58
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$27.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$27.20
|
| Rate for Payer: EmblemHealth Medicaid |
$27.20
|
| Rate for Payer: EmblemHealth Medicare |
$11.56
|
| Rate for Payer: Fidelis Medicare |
$13.60
|
| Rate for Payer: Galaxy Health Commercial |
$22.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.60
|
| Rate for Payer: Humana Medicare |
$13.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$23.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$25.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$19.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.28
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.10
|
| Rate for Payer: United Healthcare Medicare |
$13.60
|
| Rate for Payer: WellCare Medicare |
$18.70
|
|
|
X-RAY EXAM HIPS, BI, 2 VIEWS
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
HCPCS 73521 26
|
| Hospital Charge Code |
5150516
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$22.10 |
| Max. Negotiated Rate |
$22.10 |
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Galaxy Health Commercial |
$22.10
|
|
|
X-RAY EXAM HIPS BI 3-4 VIEWS
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
HCPCS 73522
|
| Hospital Charge Code |
4150517
|
|
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 HIPS BI 3-4 VIEWS
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
HCPCS 73522
|
| Hospital Charge Code |
4150517
|
|
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 HIPS, BI, 3-4 VIEWS
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
HCPCS 73522 26
|
| Hospital Charge Code |
5150517
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$28.60 |
| Max. Negotiated Rate |
$28.60 |
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Galaxy Health Commercial |
$28.60
|
|
|
X-RAY EXAM HIPS, BI, 3-4 VIEWS
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
HCPCS 73522 26
|
| Hospital Charge Code |
5150517
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$35.20 |
| Rate for Payer: Aetna of NY Commercial |
$30.80
|
| Rate for Payer: Aetna of NY Medicare |
$20.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$17.60
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: CDPHP Medicare |
$16.28
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$35.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$35.20
|
| Rate for Payer: EmblemHealth Medicaid |
$35.20
|
| Rate for Payer: EmblemHealth Medicare |
$14.96
|
| Rate for Payer: Fidelis Medicare |
$17.60
|
| Rate for Payer: Galaxy Health Commercial |
$28.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$17.60
|
| Rate for Payer: Humana Medicare |
$17.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$30.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$20.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$33.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$24.77
|
| Rate for Payer: MVP Health Care of NY Medicare |
$18.48
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.60
|
| Rate for Payer: United Healthcare Medicare |
$17.60
|
| Rate for Payer: WellCare Medicare |
$24.20
|
|
|
X-RAY EXAM HIPS BI 5/> VIEWS
|
Facility
|
OP
|
$596.00
|
|
|
Service Code
|
HCPCS 73523 TC
|
| Hospital Charge Code |
4150227
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.40 |
| Max. Negotiated Rate |
$476.80 |
| Rate for Payer: Aetna of NY Commercial |
$357.60
|
| Rate for Payer: Aetna of NY Medicare |
$274.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$238.40
|
| Rate for Payer: Cash Price |
$447.00
|
| Rate for Payer: Cash Price |
$447.00
|
| Rate for Payer: CDPHP Medicare |
$220.52
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$417.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$476.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$476.80
|
| Rate for Payer: EmblemHealth Medicaid |
$476.80
|
| Rate for Payer: EmblemHealth Medicare |
$202.64
|
| Rate for Payer: EmblemHealth Select Care |
$387.40
|
| Rate for Payer: Fidelis Medicare |
$238.40
|
| Rate for Payer: Galaxy Health Commercial |
$387.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$238.40
|
| Rate for Payer: Humana Medicare |
$238.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$357.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$274.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$447.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$335.55
|
| Rate for Payer: MVP Health Care of NY Medicare |
$250.32
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$402.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$89.40
|
| Rate for Payer: United Healthcare Commercial |
$402.00
|
| Rate for Payer: United Healthcare Medicare |
$238.40
|
| Rate for Payer: WellCare Medicare |
$327.80
|
|
|
X-RAY EXAM HIPS BI 5/> VIEWS
|
Facility
|
IP
|
$596.00
|
|
|
Service Code
|
HCPCS 73523 TC
|
| Hospital Charge Code |
4150227
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$387.40 |
| Max. Negotiated Rate |
$387.40 |
| Rate for Payer: Cash Price |
$447.00
|
| Rate for Payer: Galaxy Health Commercial |
$387.40
|
|
|
X-RAY EXAM HIPS, BILAT, 5>/ VIEWS
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
HCPCS 73523 26
|
| Hospital Charge Code |
5150227
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$7.05 |
| Max. Negotiated Rate |
$37.60 |
| Rate for Payer: Aetna of NY Commercial |
$32.90
|
| Rate for Payer: Aetna of NY Medicare |
$21.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.80
|
| Rate for Payer: Cash Price |
$35.25
|
| Rate for Payer: CDPHP Medicare |
$17.39
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$37.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$37.60
|
| Rate for Payer: EmblemHealth Medicaid |
$37.60
|
| Rate for Payer: EmblemHealth Medicare |
$15.98
|
| Rate for Payer: Fidelis Medicare |
$18.80
|
| Rate for Payer: Galaxy Health Commercial |
$30.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.80
|
| Rate for Payer: Humana Medicare |
$18.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$32.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$21.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$35.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$26.46
|
| Rate for Payer: MVP Health Care of NY Medicare |
$19.74
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.05
|
| Rate for Payer: United Healthcare Medicare |
$18.80
|
| Rate for Payer: WellCare Medicare |
$25.85
|
|
|
X-RAY EXAM HIPS, BILAT, 5>/ VIEWS
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
HCPCS 73523 26
|
| Hospital Charge Code |
5150227
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$30.55 |
| Max. Negotiated Rate |
$30.55 |
| Rate for Payer: Cash Price |
$35.25
|
| Rate for Payer: Galaxy Health Commercial |
$30.55
|
|
|
X-RAY EXAM HIP UNI 1 VIEW, LEFT
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
HCPCS 73501 TC,LT
|
| Hospital Charge Code |
4150074
|
|
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 HIP UNI 1 VIEW, LEFT
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
HCPCS 73501 TC,LT
|
| Hospital Charge Code |
4150074
|
|
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
|
|
