|
X-RAY EXAM OF ARM INFANT, 2+ VIEWS, RIGHT
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
HCPCS 73092 26,RT
|
| Hospital Charge Code |
5150515
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$19.20 |
| Rate for Payer: Aetna of NY Commercial |
$16.80
|
| Rate for Payer: Aetna of NY Medicare |
$11.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.60
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: CDPHP Medicare |
$8.88
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$19.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$19.20
|
| Rate for Payer: EmblemHealth Medicaid |
$19.20
|
| Rate for Payer: EmblemHealth Medicare |
$8.16
|
| Rate for Payer: Fidelis Medicare |
$9.60
|
| Rate for Payer: Galaxy Health Commercial |
$15.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.60
|
| Rate for Payer: Humana Medicare |
$9.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$11.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$18.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$13.51
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.08
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.60
|
| Rate for Payer: United Healthcare Medicare |
$9.60
|
| Rate for Payer: WellCare Medicare |
$13.20
|
|
|
X-RAY EXAM OF ARM INFANT, BILAT, 2+ VIEWS
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
HCPCS 73092 26,50
|
| Hospital Charge Code |
5150513
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$15.60 |
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Galaxy Health Commercial |
$15.60
|
|
|
X-RAY EXAM OF ARM INFANT, BILAT, 2+ VIEWS
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
HCPCS 73092 26,50
|
| Hospital Charge Code |
5150513
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$19.20 |
| Rate for Payer: Aetna of NY Commercial |
$16.80
|
| Rate for Payer: Aetna of NY Medicare |
$11.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.60
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: CDPHP Medicare |
$8.88
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$19.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$19.20
|
| Rate for Payer: EmblemHealth Medicaid |
$19.20
|
| Rate for Payer: EmblemHealth Medicare |
$8.16
|
| Rate for Payer: Fidelis Medicare |
$9.60
|
| Rate for Payer: Galaxy Health Commercial |
$15.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.60
|
| Rate for Payer: Humana Medicare |
$9.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$11.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$18.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$13.51
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.08
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.60
|
| Rate for Payer: United Healthcare Medicare |
$9.60
|
| Rate for Payer: WellCare Medicare |
$13.20
|
|
|
X-RAY EXAM OF BLADDER 3+ VIEWS, CONTRAST
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 74430
|
| Hospital Charge Code |
4150328
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$715.00 |
| Max. Negotiated Rate |
$715.00 |
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Galaxy Health Commercial |
$715.00
|
|
|
X-RAY EXAM OF BLADDER 3+ VIEWS, CONTRAST
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 74430
|
| Hospital Charge Code |
4150328
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$880.00 |
| Rate for Payer: Aetna of NY Commercial |
$660.00
|
| Rate for Payer: Aetna of NY Medicare |
$506.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$440.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: CDPHP Medicare |
$407.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$770.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$880.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$880.00
|
| Rate for Payer: EmblemHealth Medicaid |
$880.00
|
| Rate for Payer: EmblemHealth Medicare |
$374.00
|
| Rate for Payer: EmblemHealth Select Care |
$715.00
|
| Rate for Payer: Fidelis Medicare |
$440.00
|
| Rate for Payer: Galaxy Health Commercial |
$715.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$440.00
|
| Rate for Payer: Humana Medicare |
$440.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$660.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$506.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$825.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$619.30
|
| Rate for Payer: MVP Health Care of NY Medicare |
$462.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$402.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$165.00
|
| Rate for Payer: United Healthcare Commercial |
$402.00
|
| Rate for Payer: United Healthcare Medicare |
$440.00
|
| Rate for Payer: WellCare Medicare |
$605.00
|
|
|
X-RAY EXAM OF BLADDER, CONTRAST, 3+ VIEWS
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
HCPCS 74430 26
|
| Hospital Charge Code |
5150328
|
|
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 OF BLADDER, CONTRAST, 3+ VIEWS
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
HCPCS 74430 26
|
| Hospital Charge Code |
5150328
|
|
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 OF BREASTBONE 2+ VIEWS
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
HCPCS 71120 TC
|
| Hospital Charge Code |
4150178
|
|
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 OF BREASTBONE 2+ VIEWS
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
HCPCS 71120 TC
|
| Hospital Charge Code |
4150178
|
|
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 OF BREASTBONE, 2+ VIEWS
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS 71120 26
|
| Hospital Charge Code |
5150178
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$19.50 |
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Galaxy Health Commercial |
$19.50
|
|
|
X-RAY EXAM OF BREASTBONE, 2+ VIEWS
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS 71120 26
|
| Hospital Charge Code |
5150178
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna of NY Commercial |
$21.00
|
| Rate for Payer: Aetna of NY Medicare |
$13.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.00
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: CDPHP Medicare |
$11.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$24.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$24.00
|
| Rate for Payer: EmblemHealth Medicaid |
$24.00
|
| Rate for Payer: EmblemHealth Medicare |
$10.20
|
| Rate for Payer: Fidelis Medicare |
$12.00
|
| Rate for Payer: Galaxy Health Commercial |
$19.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.00
|
| Rate for Payer: Humana Medicare |
$12.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$21.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$13.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$22.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$16.89
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.50
|
| Rate for Payer: United Healthcare Medicare |
$12.00
|
| Rate for Payer: WellCare Medicare |
$16.50
|
|
|
X-RAY EXAM OF BREASTBONE 3+ VIEWS
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
HCPCS 71130 TC
|
| Hospital Charge Code |
4150163
|
|
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 OF BREASTBONE 3+ VIEWS
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
HCPCS 71130 TC
|
| Hospital Charge Code |
4150163
|
|
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 OF BREASTBONE 3+ VIEWS
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
HCPCS 71130 TC
|
| Hospital Charge Code |
4150332
|
|
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 OF BREASTBONE 3+ VIEWS
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
HCPCS 71130 TC
|
| Hospital Charge Code |
4150332
|
|
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 OF BREASTBONE, 3+ VIEWS
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
HCPCS 71130 26
|
| Hospital Charge Code |
5150163
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$21.45 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Galaxy Health Commercial |
$21.45
|
|
|
X-RAY EXAM OF BREASTBONE, 3+ VIEWS
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
HCPCS 71130 26
|
| Hospital Charge Code |
5150163
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$26.40 |
| Rate for Payer: Aetna of NY Commercial |
$23.10
|
| Rate for Payer: Aetna of NY Medicare |
$15.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.20
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: CDPHP Medicare |
$12.21
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$26.40
|
| Rate for Payer: EmblemHealth Medicaid |
$26.40
|
| Rate for Payer: EmblemHealth Medicare |
$11.22
|
| Rate for Payer: Fidelis Medicare |
$13.20
|
| Rate for Payer: Galaxy Health Commercial |
$21.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.20
|
| Rate for Payer: Humana Medicare |
$13.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$23.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$18.58
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.86
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.95
|
| Rate for Payer: United Healthcare Medicare |
$13.20
|
| Rate for Payer: WellCare Medicare |
$18.15
|
|
|
X-RAY EXAM OF BREASTBONE, 3+ VIEWS
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
HCPCS 71130 26
|
| Hospital Charge Code |
5150332
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$21.45 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Galaxy Health Commercial |
$21.45
|
|
|
X-RAY EXAM OF BREASTBONE, 3+ VIEWS
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
HCPCS 71130 26
|
| Hospital Charge Code |
5150332
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$26.40 |
| Rate for Payer: Aetna of NY Commercial |
$23.10
|
| Rate for Payer: Aetna of NY Medicare |
$15.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.20
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: CDPHP Medicare |
$12.21
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$26.40
|
| Rate for Payer: EmblemHealth Medicaid |
$26.40
|
| Rate for Payer: EmblemHealth Medicare |
$11.22
|
| Rate for Payer: Fidelis Medicare |
$13.20
|
| Rate for Payer: Galaxy Health Commercial |
$21.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.20
|
| Rate for Payer: Humana Medicare |
$13.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$23.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$18.58
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.86
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.95
|
| Rate for Payer: United Healthcare Medicare |
$13.20
|
| Rate for Payer: WellCare Medicare |
$18.15
|
|
|
X-RAY EXAM OF CLAVICLE COMPLETE
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
HCPCS 73000 TC
|
| Hospital Charge Code |
4150179
|
|
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 OF CLAVICLE COMPLETE
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
HCPCS 73000 TC
|
| Hospital Charge Code |
4150179
|
|
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 OF CLAVICLE COMPLETE
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
HCPCS 73000 26
|
| Hospital Charge Code |
5150179
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3.75 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna of NY Commercial |
$17.50
|
| Rate for Payer: Aetna of NY Medicare |
$11.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$10.00
|
| Rate for Payer: Cash Price |
$18.75
|
| Rate for Payer: CDPHP Medicare |
$9.25
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$20.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$20.00
|
| Rate for Payer: EmblemHealth Medicaid |
$20.00
|
| Rate for Payer: EmblemHealth Medicare |
$8.50
|
| Rate for Payer: Fidelis Medicare |
$10.00
|
| Rate for Payer: Galaxy Health Commercial |
$16.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$10.00
|
| Rate for Payer: Humana Medicare |
$10.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$17.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$11.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$18.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$14.07
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.75
|
| Rate for Payer: United Healthcare Medicare |
$10.00
|
| Rate for Payer: WellCare Medicare |
$13.75
|
|
|
X-RAY EXAM OF CLAVICLE COMPLETE
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
HCPCS 73000 26
|
| Hospital Charge Code |
5150179
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$16.25 |
| Rate for Payer: Cash Price |
$18.75
|
| Rate for Payer: Galaxy Health Commercial |
$16.25
|
|
|
X-RAY EXAM OF CLAVICLE, LEFT
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
HCPCS 73000 26,LT
|
| Hospital Charge Code |
5150068
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3.75 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna of NY Commercial |
$17.50
|
| Rate for Payer: Aetna of NY Medicare |
$11.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$10.00
|
| Rate for Payer: Cash Price |
$18.75
|
| Rate for Payer: CDPHP Medicare |
$9.25
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$20.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$20.00
|
| Rate for Payer: EmblemHealth Medicaid |
$20.00
|
| Rate for Payer: EmblemHealth Medicare |
$8.50
|
| Rate for Payer: Fidelis Medicare |
$10.00
|
| Rate for Payer: Galaxy Health Commercial |
$16.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$10.00
|
| Rate for Payer: Humana Medicare |
$10.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$17.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$11.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$18.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$14.07
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.75
|
| Rate for Payer: United Healthcare Medicare |
$10.00
|
| Rate for Payer: WellCare Medicare |
$13.75
|
|
|
X-RAY EXAM OF CLAVICLE, LEFT
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
HCPCS 73000 LT
|
| Hospital Charge Code |
4150068
|
|
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
|
|
