|
X-RAY EXAM OF KNEE, 3 VIEWS, LEFT
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
HCPCS 73562 26,LT
|
| Hospital Charge Code |
5150114
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$23.20 |
| Rate for Payer: Aetna of NY Commercial |
$20.30
|
| Rate for Payer: Aetna of NY Medicare |
$13.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.60
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: CDPHP Medicare |
$10.73
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$23.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$23.20
|
| Rate for Payer: EmblemHealth Medicaid |
$23.20
|
| Rate for Payer: EmblemHealth Medicare |
$9.86
|
| Rate for Payer: Fidelis Medicare |
$11.60
|
| Rate for Payer: Galaxy Health Commercial |
$18.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.60
|
| Rate for Payer: Humana Medicare |
$11.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$20.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$13.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$16.33
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.18
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.35
|
| Rate for Payer: United Healthcare Medicare |
$11.60
|
| Rate for Payer: WellCare Medicare |
$15.95
|
|
|
X-RAY EXAM OF KNEE, 3 VIEWS, LEFT
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
HCPCS 73562 26,LT
|
| Hospital Charge Code |
5150114
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$18.85 |
| Max. Negotiated Rate |
$18.85 |
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Galaxy Health Commercial |
$18.85
|
|
|
X-RAY EXAM OF KNEE, 3 VIEWS, RIGHT
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
HCPCS 73562 26,RT
|
| Hospital Charge Code |
5150092
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$18.85 |
| Max. Negotiated Rate |
$18.85 |
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Galaxy Health Commercial |
$18.85
|
|
|
X-RAY EXAM OF KNEE, 3 VIEWS, RIGHT
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
HCPCS 73562 26,RT
|
| Hospital Charge Code |
5150092
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$23.20 |
| Rate for Payer: Aetna of NY Commercial |
$20.30
|
| Rate for Payer: Aetna of NY Medicare |
$13.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.60
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: CDPHP Medicare |
$10.73
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$23.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$23.20
|
| Rate for Payer: EmblemHealth Medicaid |
$23.20
|
| Rate for Payer: EmblemHealth Medicare |
$9.86
|
| Rate for Payer: Fidelis Medicare |
$11.60
|
| Rate for Payer: Galaxy Health Commercial |
$18.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.60
|
| Rate for Payer: Humana Medicare |
$11.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$20.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$13.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$16.33
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.18
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.35
|
| Rate for Payer: United Healthcare Medicare |
$11.60
|
| Rate for Payer: WellCare Medicare |
$15.95
|
|
|
X-RAY EXAM OF KNEE, 4 OR MORE VIEWS, LEFT
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
HCPCS 73564 26,LT
|
| Hospital Charge Code |
5150115
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Aetna of NY Commercial |
$24.50
|
| Rate for Payer: Aetna of NY Medicare |
$16.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.00
|
| Rate for Payer: Cash Price |
$26.25
|
| Rate for Payer: CDPHP Medicare |
$12.95
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$28.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$28.00
|
| Rate for Payer: EmblemHealth Medicaid |
$28.00
|
| Rate for Payer: EmblemHealth Medicare |
$11.90
|
| Rate for Payer: Fidelis Medicare |
$14.00
|
| Rate for Payer: Galaxy Health Commercial |
$22.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.00
|
| Rate for Payer: Humana Medicare |
$14.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$24.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$16.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$26.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$19.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.70
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.25
|
| Rate for Payer: United Healthcare Medicare |
$14.00
|
| Rate for Payer: WellCare Medicare |
$19.25
|
|
|
X-RAY EXAM OF KNEE, 4 OR MORE VIEWS, LEFT
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
HCPCS 73564 26,LT
|
| Hospital Charge Code |
5150115
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$22.75 |
| Rate for Payer: Cash Price |
$26.25
|
| Rate for Payer: Galaxy Health Commercial |
$22.75
|
|
|
X-RAY EXAM OF KNEE, 4 OR MORE VIEWS, RIGHT
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
HCPCS 73564 26,RT
|
| Hospital Charge Code |
5150093
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$22.75 |
| Rate for Payer: Cash Price |
$26.25
|
| Rate for Payer: Galaxy Health Commercial |
$22.75
|
|
|
X-RAY EXAM OF KNEE, 4 OR MORE VIEWS, RIGHT
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
HCPCS 73564 26,RT
|
| Hospital Charge Code |
5150093
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Aetna of NY Commercial |
$24.50
|
| Rate for Payer: Aetna of NY Medicare |
$16.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.00
|
| Rate for Payer: Cash Price |
$26.25
|
| Rate for Payer: CDPHP Medicare |
$12.95
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$28.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$28.00
|
| Rate for Payer: EmblemHealth Medicaid |
$28.00
|
| Rate for Payer: EmblemHealth Medicare |
$11.90
|
| Rate for Payer: Fidelis Medicare |
$14.00
|
| Rate for Payer: Galaxy Health Commercial |
$22.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.00
|
| Rate for Payer: Humana Medicare |
$14.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$24.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$16.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$26.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$19.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.70
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.25
|
| Rate for Payer: United Healthcare Medicare |
$14.00
|
| Rate for Payer: WellCare Medicare |
$19.25
|
|
|
X-RAY EXAM OF KNEE; BOTH KNEES STANDING AP
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
HCPCS 73565 26
|
| Hospital Charge Code |
5150094
|
|
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 KNEE; BOTH KNEES STANDING AP
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
HCPCS 73565 26
|
| Hospital Charge Code |
5150094
|
|
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 LEG INFANT 2 VIEWS, BILATERAL
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
HCPCS 73592 TC,50
|
| Hospital Charge Code |
4150518
|
|
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 LEG INFANT 2 VIEWS, BILATERAL
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
HCPCS 73592 TC,50
|
| Hospital Charge Code |
4150518
|
|
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 LEG INFANT 2 VIEWS, LEFT
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
HCPCS 73592 TC,LT
|
| Hospital Charge Code |
4150519
|
|
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 LEG INFANT 2 VIEWS, LEFT
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
HCPCS 73592 TC,LT
|
| Hospital Charge Code |
4150519
|
|
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 LEG INFANT, 2+ VIEWS, LEFT
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
HCPCS 73592 26,LT
|
| Hospital Charge Code |
5150519
|
|
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 LEG INFANT, 2+ VIEWS, LEFT
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
HCPCS 73592 26,LT
|
| Hospital Charge Code |
5150519
|
|
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 LEG INFANT 2 VIEWS, RIGHT
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
HCPCS 73592 TC,RT
|
| Hospital Charge Code |
4150520
|
|
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 LEG INFANT 2 VIEWS, RIGHT
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
HCPCS 73592 TC,RT
|
| Hospital Charge Code |
4150520
|
|
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 LEG INFANT, 2+ VIEWS, RIGHT
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
HCPCS 73592 26,RT
|
| Hospital Charge Code |
5150520
|
|
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 LEG INFANT, 2+ VIEWS, RIGHT
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
HCPCS 73592 26,RT
|
| Hospital Charge Code |
5150520
|
|
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 LEG INFANT, BI, 2 VIEWS
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
HCPCS 73592 26,50
|
| Hospital Charge Code |
5150518
|
|
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 LEG INFANT, BI, 2 VIEWS
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
HCPCS 73592 26,50
|
| Hospital Charge Code |
5150518
|
|
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 LOWER LED, 2 VIEWS, RIGHT
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
HCPCS 73590 26,RT
|
| Hospital Charge Code |
5150183
|
|
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 LOWER LED, 2 VIEWS, RIGHT
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
HCPCS 73590 26,RT
|
| Hospital Charge Code |
5150183
|
|
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 LOWER LEG 2 VIEWS, LEFT
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
HCPCS 73590 LT
|
| Hospital Charge Code |
4150121
|
|
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
|
|
