|
X-RAY EXAM OF SHOULDER 2+ VIEWS, LEFT SIDE
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
HCPCS 73030 TC,LT
|
| Hospital Charge Code |
4150120
|
|
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 SHOULDER, 2+ VIEWS, RIGHT
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
HCPCS 73030 26,RT
|
| Hospital Charge Code |
5150169
|
|
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 SHOULDER, 2+ VIEWS, RIGHT
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
HCPCS 73030 26,RT
|
| Hospital Charge Code |
5150169
|
|
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 SHOULDER 2+ VIEWS, RIGHT SIDE
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
HCPCS 73030 TC,RT
|
| Hospital Charge Code |
4150169
|
|
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 SHOULDER 2+ VIEWS, RIGHT SIDE
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
HCPCS 73030 TC,RT
|
| Hospital Charge Code |
4150169
|
|
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 SHOULDER, BILAT, 1 VIEW
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS 73020 26,50
|
| Hospital Charge Code |
5150236
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$14.95 |
| Max. Negotiated Rate |
$14.95 |
| Rate for Payer: Cash Price |
$17.25
|
| Rate for Payer: Galaxy Health Commercial |
$14.95
|
|
|
X-RAY EXAM OF SHOULDER, BILAT, 1 VIEW
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS 73020 26,50
|
| Hospital Charge Code |
5150236
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$18.40 |
| Rate for Payer: Aetna of NY Commercial |
$16.10
|
| Rate for Payer: Aetna of NY Medicare |
$10.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.20
|
| Rate for Payer: Cash Price |
$17.25
|
| Rate for Payer: CDPHP Medicare |
$8.51
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$18.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$18.40
|
| Rate for Payer: EmblemHealth Medicaid |
$18.40
|
| Rate for Payer: EmblemHealth Medicare |
$7.82
|
| Rate for Payer: Fidelis Medicare |
$9.20
|
| Rate for Payer: Galaxy Health Commercial |
$14.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.20
|
| Rate for Payer: Humana Medicare |
$9.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.95
|
| Rate for Payer: MVP Health Care of NY Medicare |
$9.66
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.45
|
| Rate for Payer: United Healthcare Medicare |
$9.20
|
| Rate for Payer: WellCare Medicare |
$12.65
|
|
|
X-RAY EXAM OF SINUSES <3 VIEWS
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
HCPCS 70210 TC
|
| Hospital Charge Code |
4150172
|
|
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 SINUSES <3 VIEWS
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
HCPCS 70210 TC
|
| Hospital Charge Code |
4150172
|
|
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 SINUSES, <3 VIEWS
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
HCPCS 70210 26
|
| Hospital Charge Code |
5150172
|
|
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 SINUSES, <3 VIEWS
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
HCPCS 70210 26
|
| Hospital Charge Code |
5150172
|
|
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 SINUSES 3+ VIEWS
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
HCPCS 70220 TC
|
| Hospital Charge Code |
4150510
|
|
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 SINUSES 3+ VIEWS
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
HCPCS 70220 TC
|
| Hospital Charge Code |
4150510
|
|
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 SINUSES, 3+ VIEWS
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
HCPCS 70220 26
|
| Hospital Charge Code |
5150510
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$21.45 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Galaxy Health Commercial |
$21.45
|
|
|
X-RAY EXAM OF SINUSES, 3+ VIEWS
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
HCPCS 70220 26
|
| Hospital Charge Code |
5150510
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$26.40 |
| Rate for Payer: Aetna of NY Commercial |
$23.10
|
| Rate for Payer: Aetna of NY Medicare |
$15.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.20
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: CDPHP Medicare |
$12.21
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$26.40
|
| Rate for Payer: EmblemHealth Medicaid |
$26.40
|
| Rate for Payer: EmblemHealth Medicare |
$11.22
|
| Rate for Payer: Fidelis Medicare |
$13.20
|
| Rate for Payer: Galaxy Health Commercial |
$21.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.20
|
| Rate for Payer: Humana Medicare |
$13.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$23.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$18.58
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.86
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.95
|
| Rate for Payer: United Healthcare Medicare |
$13.20
|
| Rate for Payer: WellCare Medicare |
$18.15
|
|
|
X-RAY EXAM OF SKULL <4 VIEWS
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
HCPCS 70250 TC
|
| Hospital Charge Code |
4150174
|
|
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 SKULL <4 VIEWS
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
HCPCS 70250 TC
|
| Hospital Charge Code |
4150174
|
|
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 SKULL, <4 VIEWS
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
HCPCS 70250 26
|
| Hospital Charge Code |
5150174
|
|
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 SKULL, <4 VIEWS
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
HCPCS 70250 26
|
| Hospital Charge Code |
5150174
|
|
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 SKULL 4+ VIEWS
|
Facility
|
IP
|
$441.00
|
|
|
Service Code
|
HCPCS 70260
|
| Hospital Charge Code |
4150194
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$286.65 |
| Max. Negotiated Rate |
$286.65 |
| Rate for Payer: Cash Price |
$330.75
|
| Rate for Payer: Galaxy Health Commercial |
$286.65
|
|
|
X-RAY EXAM OF SKULL 4+ VIEWS
|
Facility
|
OP
|
$441.00
|
|
|
Service Code
|
HCPCS 70260
|
| Hospital Charge Code |
4150194
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$66.15 |
| Max. Negotiated Rate |
$402.00 |
| Rate for Payer: Aetna of NY Commercial |
$264.60
|
| Rate for Payer: Aetna of NY Medicare |
$202.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$176.40
|
| Rate for Payer: Cash Price |
$330.75
|
| Rate for Payer: Cash Price |
$330.75
|
| Rate for Payer: CDPHP Medicare |
$163.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$308.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$352.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$352.80
|
| Rate for Payer: EmblemHealth Medicaid |
$352.80
|
| Rate for Payer: EmblemHealth Medicare |
$149.94
|
| Rate for Payer: EmblemHealth Select Care |
$286.65
|
| Rate for Payer: Fidelis Medicare |
$176.40
|
| Rate for Payer: Galaxy Health Commercial |
$286.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$176.40
|
| Rate for Payer: Humana Medicare |
$176.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$264.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$202.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$330.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$248.28
|
| Rate for Payer: MVP Health Care of NY Medicare |
$185.22
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$402.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$66.15
|
| Rate for Payer: United Healthcare Commercial |
$402.00
|
| Rate for Payer: United Healthcare Medicare |
$176.40
|
| Rate for Payer: WellCare Medicare |
$242.55
|
|
|
X-RAY EXAM OF SKULL, 4+ VIEWS
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
HCPCS 70260 26
|
| Hospital Charge Code |
5150194
|
|
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 SKULL, 4+ VIEWS
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
HCPCS 70260 26
|
| Hospital Charge Code |
5150194
|
|
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 SPINE 1 VIEW
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
HCPCS 72020 TC
|
| Hospital Charge Code |
4150339
|
|
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 SPINE 1 VIEW
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
HCPCS 72020 TC
|
| Hospital Charge Code |
4150339
|
|
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
|
|
