|
X-RAY EXAM OF HUMERUS, 2+ VIEWS, LEFT
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
HCPCS 73060 26,LT
|
| Hospital Charge Code |
5150088
|
|
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 HUMERUS 2+ VIEWS, RIGHT
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
HCPCS 73060 TC,RT
|
| Hospital Charge Code |
4150082
|
|
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 HUMERUS 2+ VIEWS, RIGHT
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
HCPCS 73060 TC,RT
|
| Hospital Charge Code |
4150082
|
|
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 HUMERUS, 2+ VIEWS, RIGHT
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
HCPCS 73060 26,RT
|
| Hospital Charge Code |
5150082
|
|
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 HUMERUS, 2+ VIEWS, RIGHT
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
HCPCS 73060 26,RT
|
| Hospital Charge Code |
5150082
|
|
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 JAW <4 VIEWS
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
HCPCS 70100
|
| Hospital Charge Code |
4150111
|
|
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 JAW <4 VIEWS
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
HCPCS 70100
|
| Hospital Charge Code |
4150111
|
|
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 JAW, <4 VIEWS
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
HCPCS 70100 26
|
| Hospital Charge Code |
5150111
|
|
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 JAW, <4 VIEWS
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
HCPCS 70100 26
|
| Hospital Charge Code |
5150111
|
|
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 JAW 4+ VIEWS
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
HCPCS 70110
|
| Hospital Charge Code |
4150135
|
|
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 JAW 4+ VIEWS
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
HCPCS 70110
|
| Hospital Charge Code |
4150135
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Galaxy Health Commercial |
$208.00
|
|
|
X-RAY EXAM OF JAW, 4+ VIEWS
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
HCPCS 70110 26
|
| Hospital Charge Code |
5150135
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$24.70 |
| Max. Negotiated Rate |
$24.70 |
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Galaxy Health Commercial |
$24.70
|
|
|
X-RAY EXAM OF JAW, 4+ VIEWS
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
HCPCS 70110 26
|
| Hospital Charge Code |
5150135
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$5.70 |
| Max. Negotiated Rate |
$30.40 |
| Rate for Payer: Aetna of NY Commercial |
$26.60
|
| Rate for Payer: Aetna of NY Medicare |
$17.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$15.20
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: CDPHP Medicare |
$14.06
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$30.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$30.40
|
| Rate for Payer: EmblemHealth Medicaid |
$30.40
|
| Rate for Payer: EmblemHealth Medicare |
$12.92
|
| Rate for Payer: Fidelis Medicare |
$15.20
|
| Rate for Payer: Galaxy Health Commercial |
$24.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$15.20
|
| Rate for Payer: Humana Medicare |
$15.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$26.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$28.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$21.39
|
| Rate for Payer: MVP Health Care of NY Medicare |
$15.96
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.70
|
| Rate for Payer: United Healthcare Medicare |
$15.20
|
| Rate for Payer: WellCare Medicare |
$20.90
|
|
|
X-RAY EXAM OF KNEE 1 OR 2, LEFT
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
HCPCS 73560 TC,LT
|
| Hospital Charge Code |
4150089
|
|
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 KNEE 1 OR 2, LEFT
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
HCPCS 73560 TC,LT
|
| Hospital Charge Code |
4150089
|
|
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 KNEE 1 OR 2, RIGHT
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
HCPCS 73560 TC,RT
|
| Hospital Charge Code |
4150091
|
|
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 KNEE 1 OR 2, RIGHT
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
HCPCS 73560 TC,RT
|
| Hospital Charge Code |
4150091
|
|
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 KNEE, 1 OR 2 VIEWS, LEFT
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
HCPCS 73560 26,LT
|
| Hospital Charge Code |
5150089
|
|
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 KNEE, 1 OR 2 VIEWS, LEFT
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
HCPCS 73560 26,LT
|
| Hospital Charge Code |
5150089
|
|
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 KNEE, 1 OR 2 VIEWS, RIGHT
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
HCPCS 73560 26,RT
|
| Hospital Charge Code |
5150091
|
|
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 KNEE, 1 OR 2 VIEWS, RIGHT
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
HCPCS 73560 26,RT
|
| Hospital Charge Code |
5150091
|
|
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 KNEE 3, LEFT
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
HCPCS 73562 TC,LT
|
| Hospital Charge Code |
4150114
|
|
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 KNEE 3, LEFT
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
HCPCS 73562 TC,LT
|
| Hospital Charge Code |
4150114
|
|
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 KNEE 3, RIGHT
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
HCPCS 73562 TC,RT
|
| Hospital Charge Code |
4150092
|
|
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 KNEE 3, RIGHT
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
HCPCS 73562 TC,RT
|
| Hospital Charge Code |
4150092
|
|
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
|
|
