Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

X-RAY EXAM HIP, UNI, 1 VIEW, LEFT

Facility

$29.00

Service Code	HCPCS 73501 26,LT
Hospital Charge Code	5150074
Hospital Revenue Code	960
Min. Negotiated Rate	$18.85
Max. Negotiated Rate	$18.85
Rate for Payer: Cash Price	$21.75
Rate for Payer: Galaxy Health Commercial	$18.85

X-RAY EXAM HIP, UNI, 1 VIEW, LEFT

Facility

$29.00

Service Code	HCPCS 73501 26,LT
Hospital Charge Code	5150074
Hospital Revenue Code	960
Min. Negotiated Rate	$4.35
Max. Negotiated Rate	$23.20
Rate for Payer: Aetna of NY Commercial	$20.30
Rate for Payer: Aetna of NY Medicare	$13.34
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$11.60
Rate for Payer: Cash Price	$21.75
Rate for Payer: CDPHP Medicare	$10.73
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$23.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$23.20
Rate for Payer: EmblemHealth Medicaid	$23.20
Rate for Payer: EmblemHealth Medicare	$9.86
Rate for Payer: Fidelis Medicare	$11.60
Rate for Payer: Galaxy Health Commercial	$18.85
Rate for Payer: Hamaspik Choice Medicare	$11.60
Rate for Payer: Humana Medicare	$11.60
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$20.30
Rate for Payer: Local 1199SEIU Medicare	$13.34
Rate for Payer: MVP Health Care of NY Commercial	$21.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$16.33
Rate for Payer: MVP Health Care of NY Medicare	$12.18
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$4.35
Rate for Payer: United Healthcare Medicare	$11.60
Rate for Payer: WellCare Medicare	$15.95

X-RAY EXAM HIP UNI 1 VIEW, RIGHT

Facility

$267.00

Service Code	HCPCS 73501 TC,RT
Hospital Charge Code	4150075
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 HIP UNI 1 VIEW, RIGHT

Facility

$267.00

Service Code	HCPCS 73501 TC,RT
Hospital Charge Code	4150075
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, RIGHT

Facility

$29.00

Service Code	HCPCS 73501 26,RT
Hospital Charge Code	5150075
Hospital Revenue Code	960
Min. Negotiated Rate	$4.35
Max. Negotiated Rate	$23.20
Rate for Payer: Aetna of NY Commercial	$20.30
Rate for Payer: Aetna of NY Medicare	$13.34
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$11.60
Rate for Payer: Cash Price	$21.75
Rate for Payer: CDPHP Medicare	$10.73
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$23.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$23.20
Rate for Payer: EmblemHealth Medicaid	$23.20
Rate for Payer: EmblemHealth Medicare	$9.86
Rate for Payer: Fidelis Medicare	$11.60
Rate for Payer: Galaxy Health Commercial	$18.85
Rate for Payer: Hamaspik Choice Medicare	$11.60
Rate for Payer: Humana Medicare	$11.60
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$20.30
Rate for Payer: Local 1199SEIU Medicare	$13.34
Rate for Payer: MVP Health Care of NY Commercial	$21.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$16.33
Rate for Payer: MVP Health Care of NY Medicare	$12.18
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$4.35
Rate for Payer: United Healthcare Medicare	$11.60
Rate for Payer: WellCare Medicare	$15.95

X-RAY EXAM HIP, UNI, 1 VIEW, RIGHT

Facility

$29.00

Service Code	HCPCS 73501 26,RT
Hospital Charge Code	5150075
Hospital Revenue Code	960
Min. Negotiated Rate	$18.85
Max. Negotiated Rate	$18.85
Rate for Payer: Cash Price	$21.75
Rate for Payer: Galaxy Health Commercial	$18.85

X-RAY EXAM HIP UNI 2-3 VIEWS, LEFT

Facility

$267.00

Service Code	HCPCS 73502 TC,LT
Hospital Charge Code	4150076
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 2-3 VIEWS, LEFT

Facility

$267.00

Service Code	HCPCS 73502 TC,LT
Hospital Charge Code	4150076
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 HIP, UNI, 2-3 VIEWS, LEFT

Facility

$34.00

Service Code	HCPCS 73502 26,LT
Hospital Charge Code	5150076
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 HIP, UNI, 2-3 VIEWS, LEFT

Facility

$34.00

Service Code	HCPCS 73502 26,LT
Hospital Charge Code	5150076
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 HIP UNI 2-3 VIEWS, RIGHT

Facility

$267.00

Service Code	HCPCS 73502 TC,RT
Hospital Charge Code	4150077
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 HIP UNI 2-3 VIEWS, RIGHT

Facility

$267.00

Service Code	HCPCS 73502 TC,RT
Hospital Charge Code	4150077
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, 2-3 VIEWS, RIGHT

Facility

$34.00

Service Code	HCPCS 73502 26,RT
Hospital Charge Code	5150077
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 HIP, UNI, 2-3 VIEWS, RIGHT

Facility

$34.00

Service Code	HCPCS 73502 26,RT
Hospital Charge Code	5150077
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 KNEE 4 OR MORE, LEFT

Facility

$320.00

Service Code	HCPCS 73564 LT
Hospital Charge Code	4150115
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 KNEE 4 OR MORE, LEFT

Facility

$320.00

Service Code	HCPCS 73564 LT
Hospital Charge Code	4150115
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 KNEE 4 OR MORE, RIGHT

Facility

$320.00

Service Code	HCPCS 73564 RT
Hospital Charge Code	4150093
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 KNEE 4 OR MORE, RIGHT

Facility

$320.00

Service Code	HCPCS 73564 RT
Hospital Charge Code	4150093
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 KNEE; BOTH KNEES STANDING AP

Facility

$267.00

Service Code	HCPCS 73565
Hospital Charge Code	4150094
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 KNEE; BOTH KNEES STANDING AP

Facility

$267.00

Service Code	HCPCS 73565
Hospital Charge Code	4150094
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 NECK SPINE 2-3 VW

Facility

$267.00

Service Code	HCPCS 72040 TC
Hospital Charge Code	4150321
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 NECK SPINE 2-3 VW

Facility

$267.00

Service Code	HCPCS 72040 TC
Hospital Charge Code	4150321
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 NECK SPINE, 4/5 VIEWS

Facility

$41.00

Service Code	HCPCS 72050 26
Hospital Charge Code	5150322
Hospital Revenue Code	960
Min. Negotiated Rate	$6.15
Max. Negotiated Rate	$32.80
Rate for Payer: Aetna of NY Commercial	$28.70
Rate for Payer: Aetna of NY Medicare	$18.86
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$16.40
Rate for Payer: Cash Price	$30.75
Rate for Payer: CDPHP Medicare	$15.17
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$32.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$32.80
Rate for Payer: EmblemHealth Medicaid	$32.80
Rate for Payer: EmblemHealth Medicare	$13.94
Rate for Payer: Fidelis Medicare	$16.40
Rate for Payer: Galaxy Health Commercial	$26.65
Rate for Payer: Hamaspik Choice Medicare	$16.40
Rate for Payer: Humana Medicare	$16.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$28.70
Rate for Payer: Local 1199SEIU Medicare	$18.86
Rate for Payer: MVP Health Care of NY Commercial	$30.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$23.08
Rate for Payer: MVP Health Care of NY Medicare	$17.22
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$6.15
Rate for Payer: United Healthcare Medicare	$16.40
Rate for Payer: WellCare Medicare	$22.55

X-RAY EXAM NECK SPINE, 4/5 VIEWS

Facility

$41.00

Service Code	HCPCS 72050 26
Hospital Charge Code	5150322
Hospital Revenue Code	960
Min. Negotiated Rate	$26.65
Max. Negotiated Rate	$26.65
Rate for Payer: Cash Price	$30.75
Rate for Payer: Galaxy Health Commercial	$26.65

X-RAY EXAM NECK SPINE 4/5VWS

Facility

$320.00

Service Code	HCPCS 72050 TC
Hospital Charge Code	4150322
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

Know your out-of-pocket cost for care.

All Charges