|
X-RAY EXAM OF FEMUR 2/>, LT
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
HCPCS 73552 TC,LT
|
| Hospital Charge Code |
4150532
|
|
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/>, LT
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
HCPCS 73552 TC,LT
|
| Hospital Charge Code |
4150532
|
|
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 2/>, RT
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
HCPCS 73552 TC,RT
|
| Hospital Charge Code |
4150533
|
|
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/>, RT
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
HCPCS 73552 TC,RT
|
| Hospital Charge Code |
4150533
|
|
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, 2>/ VIEWS
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
HCPCS 73552 26
|
| Hospital Charge Code |
5150146
|
|
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 FEMUR, 2>/ VIEWS
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
HCPCS 73552 26
|
| Hospital Charge Code |
5150146
|
|
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 FEMUR, 2>/ VIEWS, LEFT
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
HCPCS 73552 26,LT
|
| Hospital Charge Code |
5150532
|
|
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 FEMUR, 2>/ VIEWS, LEFT
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
HCPCS 73552 26,LT
|
| Hospital Charge Code |
5150532
|
|
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 FEMUR, 2/> VIEWS, RIGHT
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
HCPCS 73552 26,RT
|
| Hospital Charge Code |
5150533
|
|
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 FEMUR, 2/> VIEWS, RIGHT
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
HCPCS 73552 26,RT
|
| Hospital Charge Code |
5150533
|
|
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 FINGER(S) 2+ VIEW, RIGHT, FIFTH DIGIT
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
HCPCS 73140 26,F9
|
| Hospital Charge Code |
5150028
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$13.65 |
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Galaxy Health Commercial |
$13.65
|
|
|
X-RAY EXAM OF FINGER(S) 2+ VIEW, RIGHT, FIFTH DIGIT
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
HCPCS 73140 26,F9
|
| Hospital Charge Code |
5150028
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$16.80 |
| Rate for Payer: Aetna of NY Commercial |
$14.70
|
| Rate for Payer: Aetna of NY Medicare |
$9.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.40
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: CDPHP Medicare |
$7.77
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$16.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$16.80
|
| Rate for Payer: EmblemHealth Medicaid |
$16.80
|
| Rate for Payer: EmblemHealth Medicare |
$7.14
|
| Rate for Payer: Fidelis Medicare |
$8.40
|
| Rate for Payer: Galaxy Health Commercial |
$13.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.40
|
| Rate for Payer: Humana Medicare |
$8.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$14.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.82
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.82
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.15
|
| Rate for Payer: United Healthcare Medicare |
$8.40
|
| Rate for Payer: WellCare Medicare |
$11.55
|
|
|
X-RAY EXAM OF FINGER(S) 2+ VIEWS, LEFT, FIFTH DIGIT
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
HCPCS 73140 26,F4
|
| Hospital Charge Code |
5150019
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$13.65 |
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Galaxy Health Commercial |
$13.65
|
|
|
X-RAY EXAM OF FINGER(S) 2+ VIEWS, LEFT, FIFTH DIGIT
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
HCPCS 73140 26,F4
|
| Hospital Charge Code |
5150019
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$16.80 |
| Rate for Payer: Aetna of NY Commercial |
$14.70
|
| Rate for Payer: Aetna of NY Medicare |
$9.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.40
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: CDPHP Medicare |
$7.77
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$16.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$16.80
|
| Rate for Payer: EmblemHealth Medicaid |
$16.80
|
| Rate for Payer: EmblemHealth Medicare |
$7.14
|
| Rate for Payer: Fidelis Medicare |
$8.40
|
| Rate for Payer: Galaxy Health Commercial |
$13.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.40
|
| Rate for Payer: Humana Medicare |
$8.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$14.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.82
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.82
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.15
|
| Rate for Payer: United Healthcare Medicare |
$8.40
|
| Rate for Payer: WellCare Medicare |
$11.55
|
|
|
X-RAY EXAM OF FINGER(S) 2+ VIEWS, LEFT, FOURTH DIGIT
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
HCPCS 73140 26,F3
|
| Hospital Charge Code |
5150018
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$16.80 |
| Rate for Payer: Aetna of NY Commercial |
$14.70
|
| Rate for Payer: Aetna of NY Medicare |
$9.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.40
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: CDPHP Medicare |
$7.77
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$16.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$16.80
|
| Rate for Payer: EmblemHealth Medicaid |
$16.80
|
| Rate for Payer: EmblemHealth Medicare |
$7.14
|
| Rate for Payer: Fidelis Medicare |
$8.40
|
| Rate for Payer: Galaxy Health Commercial |
$13.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.40
|
| Rate for Payer: Humana Medicare |
$8.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$14.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.82
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.82
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.15
|
| Rate for Payer: United Healthcare Medicare |
$8.40
|
| Rate for Payer: WellCare Medicare |
$11.55
|
|
|
X-RAY EXAM OF FINGER(S) 2+ VIEWS, LEFT, FOURTH DIGIT
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
HCPCS 73140 26,F3
|
| Hospital Charge Code |
5150018
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$13.65 |
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Galaxy Health Commercial |
$13.65
|
|
|
X-RAY EXAM OF FINGER(S) 2+ VIEWS, LEFT, SECOND DIGIT
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
HCPCS 73140 26,F1
|
| Hospital Charge Code |
5150016
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$13.65 |
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Galaxy Health Commercial |
$13.65
|
|
|
X-RAY EXAM OF FINGER(S) 2+ VIEWS, LEFT, SECOND DIGIT
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
HCPCS 73140 26,F1
|
| Hospital Charge Code |
5150016
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$16.80 |
| Rate for Payer: Aetna of NY Commercial |
$14.70
|
| Rate for Payer: Aetna of NY Medicare |
$9.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.40
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: CDPHP Medicare |
$7.77
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$16.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$16.80
|
| Rate for Payer: EmblemHealth Medicaid |
$16.80
|
| Rate for Payer: EmblemHealth Medicare |
$7.14
|
| Rate for Payer: Fidelis Medicare |
$8.40
|
| Rate for Payer: Galaxy Health Commercial |
$13.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.40
|
| Rate for Payer: Humana Medicare |
$8.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$14.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.82
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.82
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.15
|
| Rate for Payer: United Healthcare Medicare |
$8.40
|
| Rate for Payer: WellCare Medicare |
$11.55
|
|
|
X-RAY EXAM OF FINGER(S) 2+ VIEWS, LEFT, THIRD DIGIT
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
HCPCS 73140 26,F2
|
| Hospital Charge Code |
5150017
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$16.80 |
| Rate for Payer: Aetna of NY Commercial |
$14.70
|
| Rate for Payer: Aetna of NY Medicare |
$9.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.40
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: CDPHP Medicare |
$7.77
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$16.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$16.80
|
| Rate for Payer: EmblemHealth Medicaid |
$16.80
|
| Rate for Payer: EmblemHealth Medicare |
$7.14
|
| Rate for Payer: Fidelis Medicare |
$8.40
|
| Rate for Payer: Galaxy Health Commercial |
$13.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.40
|
| Rate for Payer: Humana Medicare |
$8.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$14.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.82
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.82
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.15
|
| Rate for Payer: United Healthcare Medicare |
$8.40
|
| Rate for Payer: WellCare Medicare |
$11.55
|
|
|
X-RAY EXAM OF FINGER(S) 2+ VIEWS, LEFT, THIRD DIGIT
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
HCPCS 73140 26,F2
|
| Hospital Charge Code |
5150017
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$13.65 |
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Galaxy Health Commercial |
$13.65
|
|
|
X-RAY EXAM OF FINGER(S), 2+ VIEWS, LEFT THUMB
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
HCPCS 73140 26,FA
|
| Hospital Charge Code |
5150219
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$16.80 |
| Rate for Payer: Aetna of NY Commercial |
$14.70
|
| Rate for Payer: Aetna of NY Medicare |
$9.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.40
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: CDPHP Medicare |
$7.77
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$16.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$16.80
|
| Rate for Payer: EmblemHealth Medicaid |
$16.80
|
| Rate for Payer: EmblemHealth Medicare |
$7.14
|
| Rate for Payer: Fidelis Medicare |
$8.40
|
| Rate for Payer: Galaxy Health Commercial |
$13.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.40
|
| Rate for Payer: Humana Medicare |
$8.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$14.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.82
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.82
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.15
|
| Rate for Payer: United Healthcare Medicare |
$8.40
|
| Rate for Payer: WellCare Medicare |
$11.55
|
|
|
X-RAY EXAM OF FINGER(S), 2+ VIEWS, LEFT THUMB
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
HCPCS 73140 26,FA
|
| Hospital Charge Code |
5150219
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$13.65 |
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Galaxy Health Commercial |
$13.65
|
|
|
X-RAY EXAM OF FINGER(S) 2+ VIEWS, LT FIFTH DIGIT
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
HCPCS 73140 F4
|
| Hospital Charge Code |
4150019
|
|
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 FINGER(S) 2+ VIEWS, LT FIFTH DIGIT
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
HCPCS 73140 F4
|
| Hospital Charge Code |
4150019
|
|
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 FINGER(S) 2+ VIEWS, LT FOURTH DIGIT
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
HCPCS 73140 F3
|
| Hospital Charge Code |
4150018
|
|
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
|
|
