|
X-RAY EXAM OF EYE SOCKETS 4+ VIEWS
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
HCPCS 70200 TC
|
| Hospital Charge Code |
4150122
|
|
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 OF EYE SOCKETS, 4+ VIEWS
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
HCPCS 70200 26
|
| Hospital Charge Code |
5150122
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$33.60 |
| Rate for Payer: Aetna of NY Commercial |
$29.40
|
| Rate for Payer: Aetna of NY Medicare |
$19.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.80
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: CDPHP Medicare |
$15.54
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$33.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$33.60
|
| Rate for Payer: EmblemHealth Medicaid |
$33.60
|
| Rate for Payer: EmblemHealth Medicare |
$14.28
|
| Rate for Payer: Fidelis Medicare |
$16.80
|
| Rate for Payer: Galaxy Health Commercial |
$27.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.80
|
| Rate for Payer: Humana Medicare |
$16.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$29.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$19.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$31.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$23.65
|
| Rate for Payer: MVP Health Care of NY Medicare |
$17.64
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.30
|
| Rate for Payer: United Healthcare Medicare |
$16.80
|
| Rate for Payer: WellCare Medicare |
$23.10
|
|
|
X-RAY EXAM OF EYE SOCKETS, 4+ VIEWS
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
HCPCS 70200 26
|
| Hospital Charge Code |
5150122
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$27.30 |
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Galaxy Health Commercial |
$27.30
|
|
|
X-RAY EXAM OF FACIAL BONES <3 VIEWS
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
HCPCS 70140 TC
|
| Hospital Charge Code |
4150113
|
|
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 FACIAL BONES <3 VIEWS
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
HCPCS 70140 TC
|
| Hospital Charge Code |
4150113
|
|
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 FACIAL BONES <3 VIEWS
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
HCPCS 70140 TC
|
| Hospital Charge Code |
4150345
|
|
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 FACIAL BONES <3 VIEWS
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
HCPCS 70140 TC
|
| Hospital Charge Code |
4150345
|
|
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 FACIAL BONES, <3 VIEWS
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
HCPCS 70140 26
|
| Hospital Charge Code |
5150113
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$24.80 |
| Rate for Payer: Aetna of NY Commercial |
$21.70
|
| Rate for Payer: Aetna of NY Medicare |
$14.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.40
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: CDPHP Medicare |
$11.47
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$24.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$24.80
|
| Rate for Payer: EmblemHealth Medicaid |
$24.80
|
| Rate for Payer: EmblemHealth Medicare |
$10.54
|
| Rate for Payer: Fidelis Medicare |
$12.40
|
| Rate for Payer: Galaxy Health Commercial |
$20.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.40
|
| Rate for Payer: Humana Medicare |
$12.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$21.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$23.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$17.45
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.02
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.65
|
| Rate for Payer: United Healthcare Medicare |
$12.40
|
| Rate for Payer: WellCare Medicare |
$17.05
|
|
|
X-RAY EXAM OF FACIAL BONES, <3 VIEWS
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
HCPCS 70140 26
|
| Hospital Charge Code |
5150345
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$24.80 |
| Rate for Payer: Aetna of NY Commercial |
$21.70
|
| Rate for Payer: Aetna of NY Medicare |
$14.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.40
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: CDPHP Medicare |
$11.47
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$24.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$24.80
|
| Rate for Payer: EmblemHealth Medicaid |
$24.80
|
| Rate for Payer: EmblemHealth Medicare |
$10.54
|
| Rate for Payer: Fidelis Medicare |
$12.40
|
| Rate for Payer: Galaxy Health Commercial |
$20.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.40
|
| Rate for Payer: Humana Medicare |
$12.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$21.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$23.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$17.45
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.02
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.65
|
| Rate for Payer: United Healthcare Medicare |
$12.40
|
| Rate for Payer: WellCare Medicare |
$17.05
|
|
|
X-RAY EXAM OF FACIAL BONES, <3 VIEWS
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
HCPCS 70140 26
|
| Hospital Charge Code |
5150113
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$20.15 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: Galaxy Health Commercial |
$20.15
|
|
|
X-RAY EXAM OF FACIAL BONES, <3 VIEWS
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
HCPCS 70140 26
|
| Hospital Charge Code |
5150345
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$20.15 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: Galaxy Health Commercial |
$20.15
|
|
|
X-RAY EXAM OF FACIAL BONES 3+ VIEWS
|
Facility
|
OP
|
$461.00
|
|
|
Service Code
|
HCPCS 70150
|
| Hospital Charge Code |
4150191
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$69.15 |
| Max. Negotiated Rate |
$402.00 |
| Rate for Payer: Aetna of NY Commercial |
$276.60
|
| Rate for Payer: Aetna of NY Medicare |
$212.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$184.40
|
| Rate for Payer: Cash Price |
$345.75
|
| Rate for Payer: Cash Price |
$345.75
|
| Rate for Payer: CDPHP Medicare |
$170.57
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$322.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$368.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$368.80
|
| Rate for Payer: EmblemHealth Medicaid |
$368.80
|
| Rate for Payer: EmblemHealth Medicare |
$156.74
|
| Rate for Payer: EmblemHealth Select Care |
$299.65
|
| Rate for Payer: Fidelis Medicare |
$184.40
|
| Rate for Payer: Galaxy Health Commercial |
$299.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$184.40
|
| Rate for Payer: Humana Medicare |
$184.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$276.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$212.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$345.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$259.54
|
| Rate for Payer: MVP Health Care of NY Medicare |
$193.62
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$402.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$69.15
|
| Rate for Payer: United Healthcare Commercial |
$402.00
|
| Rate for Payer: United Healthcare Medicare |
$184.40
|
| Rate for Payer: WellCare Medicare |
$253.55
|
|
|
X-RAY EXAM OF FACIAL BONES 3+ VIEWS
|
Facility
|
IP
|
$461.00
|
|
|
Service Code
|
HCPCS 70150
|
| Hospital Charge Code |
4150191
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$299.65 |
| Max. Negotiated Rate |
$299.65 |
| Rate for Payer: Cash Price |
$345.75
|
| Rate for Payer: Galaxy Health Commercial |
$299.65
|
|
|
X-RAY EXAM OF FACIAL BONES, 3+ VIEWS
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
HCPCS 70150 26
|
| Hospital Charge Code |
5150191
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$25.35 |
| Max. Negotiated Rate |
$25.35 |
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Galaxy Health Commercial |
$25.35
|
|
|
X-RAY EXAM OF FACIAL BONES, 3+ VIEWS
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
HCPCS 70150 26
|
| Hospital Charge Code |
5150191
|
|
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 OF FEMUR 1, LEFT
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
HCPCS 73551 TC,LT
|
| Hospital Charge Code |
4150078
|
|
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 FEMUR 1, LEFT
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
HCPCS 73551 TC,LT
|
| Hospital Charge Code |
4150078
|
|
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 FEMUR 1, RIGHT
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
HCPCS 73551 TC,RT
|
| Hospital Charge Code |
4150060
|
|
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 FEMUR 1, RIGHT
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
HCPCS 73551 TC,RT
|
| Hospital Charge Code |
4150060
|
|
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 FEMUR, 1 VIEW, LEFT
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
HCPCS 73551 26,LT
|
| Hospital Charge Code |
5150078
|
|
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 FEMUR, 1 VIEW, LEFT
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
HCPCS 73551 26,LT
|
| Hospital Charge Code |
5150078
|
|
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 FEMUR, 1 VIEW, RIGHT
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
HCPCS 73551 26,RT
|
| Hospital Charge Code |
5150060
|
|
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 FEMUR, 1 VIEW, RIGHT
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
HCPCS 73551 26,RT
|
| Hospital Charge Code |
5150060
|
|
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 FEMUR 2/>
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
HCPCS 73552 TC
|
| Hospital Charge Code |
4150146
|
|
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 FEMUR 2/>
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
HCPCS 73552 TC
|
| Hospital Charge Code |
4150146
|
|
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
|
|
