Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

X-RAY EXAM OF CLAVICLE, LEFT

Facility

$267.00

Service Code	HCPCS 73000 LT
Hospital Charge Code	4150068
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, LEFT

Facility

$25.00

Service Code	HCPCS 73000 26,LT
Hospital Charge Code	5150068
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, RIGHT

Facility

$25.00

Service Code	HCPCS 73000 26,RT
Hospital Charge Code	5150326
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, RIGHT

Facility

$267.00

Service Code	HCPCS 73000 RT
Hospital Charge Code	4150326
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, RIGHT

Facility

$25.00

Service Code	HCPCS 73000 26,RT
Hospital Charge Code	5150326
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, RIGHT

Facility

$267.00

Service Code	HCPCS 73000 RT
Hospital Charge Code	4150326
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 ELBOW 2 VIEWS, LEFT

Facility

$267.00

Service Code	HCPCS 73070 TC,LT
Hospital Charge Code	4150069
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 ELBOW 2 VIEWS, LEFT

Facility

$267.00

Service Code	HCPCS 73070 TC,LT
Hospital Charge Code	4150069
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 ELBOW, 2 VIEWS, LEFT

Facility

$25.00

Service Code	HCPCS 73070 26,LT
Hospital Charge Code	5150069
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 ELBOW, 2 VIEWS, LEFT

Facility

$25.00

Service Code	HCPCS 73070 26,LT
Hospital Charge Code	5150069
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 ELBOW 2 VIEWS, RIGHT

Facility

$25.00

Service Code	HCPCS 73070 26,RT
Hospital Charge Code	5150050
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 ELBOW 2 VIEWS, RIGHT

Facility

$267.00

Service Code	HCPCS 73070 TC,RT
Hospital Charge Code	4150050
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 ELBOW 2 VIEWS, RIGHT

Facility

$267.00

Service Code	HCPCS 73070 TC,RT
Hospital Charge Code	4150050
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 ELBOW 2 VIEWS, RIGHT

Facility

$25.00

Service Code	HCPCS 73070 26,RT
Hospital Charge Code	5150050
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 ELBOW 3+ VIEWS, LEFT

Facility

$267.00

Service Code	HCPCS 73080 LT
Hospital Charge Code	4150070
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 ELBOW 3+ VIEWS, LEFT

Facility

$267.00

Service Code	HCPCS 73080 LT
Hospital Charge Code	4150070
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 ELBOW, 3+ VIEWS, LEFT

Facility

$27.00

Service Code	HCPCS 73080 26,LT
Hospital Charge Code	5150070
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 OF ELBOW, 3+ VIEWS, LEFT

Facility

$27.00

Service Code	HCPCS 73080 26,LT
Hospital Charge Code	5150070
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 OF ELBOW 3+ VIEWS, RIGHT

Facility

$267.00

Service Code	HCPCS 73080 RT
Hospital Charge Code	4150051
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 ELBOW 3+ VIEWS, RIGHT

Facility

$27.00

Service Code	HCPCS 73080 26,RT
Hospital Charge Code	5150051
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 OF ELBOW 3+ VIEWS, RIGHT

Facility

$267.00

Service Code	HCPCS 73080 RT
Hospital Charge Code	4150051
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 ELBOW 3+ VIEWS, RIGHT

Facility

$27.00

Service Code	HCPCS 73080 26,RT
Hospital Charge Code	5150051
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 OF ENTIRE SPINE, 2/3 VIEWS

Facility

$47.00

Service Code	HCPCS 72082 26
Hospital Charge Code	5150331
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 ENTIRE SPINE, 2/3 VIEWS

Facility

$47.00

Service Code	HCPCS 72082 26
Hospital Charge Code	5150331
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 EYE SOCKETS 4+ VIEWS

Facility

$320.00

Service Code	HCPCS 70200 TC
Hospital Charge Code	4150122
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