|
X-RAY EXAM OF SPINE, 1 VIEW
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
HCPCS 72020 26
|
| Hospital Charge Code |
5150339
|
|
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 SPINE, 1 VIEW
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
HCPCS 72020 26
|
| Hospital Charge Code |
5150339
|
|
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 TAILBONE 2+ VIEWS
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
HCPCS 72220
|
| Hospital Charge Code |
4150162
|
|
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 TAILBONE 2+ VIEWS
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
HCPCS 72220
|
| Hospital Charge Code |
4150162
|
|
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 TAILBONE, 2+ VIEWS
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
HCPCS 72220 26
|
| Hospital Charge Code |
5150162
|
|
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 TAILBONE, 2+ VIEWS
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
HCPCS 72220 26
|
| Hospital Charge Code |
5150162
|
|
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 TEMPOROMANDIBULAR JOINT, BILAT
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
HCPCS 70330
|
| Hospital Charge Code |
4150180
|
|
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 TEMPOROMANDIBULAR JOINT, BILAT
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS 70330 26
|
| Hospital Charge Code |
5150180
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Galaxy Health Commercial |
$23.40
|
|
|
X-RAY EXAM OF TEMPOROMANDIBULAR JOINT, BILAT
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS 70330 26
|
| Hospital Charge Code |
5150180
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of NY Commercial |
$25.20
|
| Rate for Payer: Aetna of NY Medicare |
$16.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.40
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: CDPHP Medicare |
$13.32
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$28.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$28.80
|
| Rate for Payer: EmblemHealth Medicaid |
$28.80
|
| Rate for Payer: EmblemHealth Medicare |
$12.24
|
| Rate for Payer: Fidelis Medicare |
$14.40
|
| Rate for Payer: Galaxy Health Commercial |
$23.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.40
|
| Rate for Payer: Humana Medicare |
$14.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$25.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$16.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$20.27
|
| Rate for Payer: MVP Health Care of NY Medicare |
$15.12
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.40
|
| Rate for Payer: United Healthcare Medicare |
$14.40
|
| Rate for Payer: WellCare Medicare |
$19.80
|
|
|
X-RAY EXAM OF TEMPOROMANDIBULAR JOINT, BILAT
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
HCPCS 70330
|
| Hospital Charge Code |
4150180
|
|
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 TEMPOROMANDIBULAR JOINT, UNILAT
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
HCPCS 70328
|
| Hospital Charge Code |
4150181
|
|
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 TEMPOROMANDIBULAR JOINT, UNILAT
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
HCPCS 70328 26
|
| Hospital Charge Code |
5150181
|
|
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 TEMPOROMANDIBULAR JOINT, UNILAT
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
HCPCS 70328 26
|
| Hospital Charge Code |
5150181
|
|
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 TEMPOROMANDIBULAR JOINT, UNILAT
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
HCPCS 70328
|
| Hospital Charge Code |
4150181
|
|
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 THORACIC SPINE 2 VIEWS
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
HCPCS 72070
|
| Hospital Charge Code |
4150222
|
|
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 THORACIC SPINE 2 VIEWS
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
HCPCS 72070
|
| Hospital Charge Code |
4150222
|
|
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 THORACIC SPINE, 2 VIEWS
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
HCPCS 72070 26
|
| Hospital Charge Code |
5150222
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$20.15 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: Galaxy Health Commercial |
$20.15
|
|
|
X-RAY EXAM OF THORACIC SPINE, 2 VIEWS
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
HCPCS 72070 26
|
| Hospital Charge Code |
5150222
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$24.80 |
| Rate for Payer: Aetna of NY Commercial |
$21.70
|
| Rate for Payer: Aetna of NY Medicare |
$14.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.40
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: CDPHP Medicare |
$11.47
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$24.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$24.80
|
| Rate for Payer: EmblemHealth Medicaid |
$24.80
|
| Rate for Payer: EmblemHealth Medicare |
$10.54
|
| Rate for Payer: Fidelis Medicare |
$12.40
|
| Rate for Payer: Galaxy Health Commercial |
$20.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.40
|
| Rate for Payer: Humana Medicare |
$12.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$21.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$23.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$17.45
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.02
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.65
|
| Rate for Payer: United Healthcare Medicare |
$12.40
|
| Rate for Payer: WellCare Medicare |
$17.05
|
|
|
X-RAY EXAM OF THORACIC SPINE 3 VIEWS
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
HCPCS 72072
|
| Hospital Charge Code |
4150256
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$326.30 |
| Max. Negotiated Rate |
$326.30 |
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: Galaxy Health Commercial |
$326.30
|
|
|
X-RAY EXAM OF THORACIC SPINE 3 VIEWS
|
Facility
|
OP
|
$502.00
|
|
|
Service Code
|
HCPCS 72072
|
| Hospital Charge Code |
4150256
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$75.30 |
| Max. Negotiated Rate |
$402.00 |
| Rate for Payer: Aetna of NY Commercial |
$301.20
|
| Rate for Payer: Aetna of NY Medicare |
$230.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$200.80
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: CDPHP Medicare |
$185.74
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$351.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$401.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$401.60
|
| Rate for Payer: EmblemHealth Medicaid |
$401.60
|
| Rate for Payer: EmblemHealth Medicare |
$170.68
|
| Rate for Payer: EmblemHealth Select Care |
$326.30
|
| Rate for Payer: Fidelis Medicare |
$200.80
|
| Rate for Payer: Galaxy Health Commercial |
$326.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$200.80
|
| Rate for Payer: Humana Medicare |
$200.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$301.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$230.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$376.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$282.63
|
| Rate for Payer: MVP Health Care of NY Medicare |
$210.84
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$402.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$75.30
|
| Rate for Payer: United Healthcare Commercial |
$402.00
|
| Rate for Payer: United Healthcare Medicare |
$200.80
|
| Rate for Payer: WellCare Medicare |
$276.10
|
|
|
X-RAY EXAM OF THORACIC SPINE, 3 VIEWS
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
HCPCS 72072 26
|
| Hospital Charge Code |
5150256
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$22.10 |
| Max. Negotiated Rate |
$22.10 |
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Galaxy Health Commercial |
$22.10
|
|
|
X-RAY EXAM OF THORACIC SPINE, 3 VIEWS
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
HCPCS 72072 26
|
| Hospital Charge Code |
5150256
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$27.20 |
| Rate for Payer: Aetna of NY Commercial |
$23.80
|
| Rate for Payer: Aetna of NY Medicare |
$15.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.60
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: CDPHP Medicare |
$12.58
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$27.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$27.20
|
| Rate for Payer: EmblemHealth Medicaid |
$27.20
|
| Rate for Payer: EmblemHealth Medicare |
$11.56
|
| Rate for Payer: Fidelis Medicare |
$13.60
|
| Rate for Payer: Galaxy Health Commercial |
$22.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.60
|
| Rate for Payer: Humana Medicare |
$13.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$23.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$25.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$19.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.28
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.10
|
| Rate for Payer: United Healthcare Medicare |
$13.60
|
| Rate for Payer: WellCare Medicare |
$18.70
|
|
|
X-RAY EXAM OF THORACIC SPINE 4+ VIEWS
|
Facility
|
OP
|
$502.00
|
|
|
Service Code
|
HCPCS 72074
|
| Hospital Charge Code |
4150258
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$75.30 |
| Max. Negotiated Rate |
$402.00 |
| Rate for Payer: Aetna of NY Commercial |
$301.20
|
| Rate for Payer: Aetna of NY Medicare |
$230.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$200.80
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: CDPHP Medicare |
$185.74
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$351.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$401.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$401.60
|
| Rate for Payer: EmblemHealth Medicaid |
$401.60
|
| Rate for Payer: EmblemHealth Medicare |
$170.68
|
| Rate for Payer: EmblemHealth Select Care |
$326.30
|
| Rate for Payer: Fidelis Medicare |
$200.80
|
| Rate for Payer: Galaxy Health Commercial |
$326.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$200.80
|
| Rate for Payer: Humana Medicare |
$200.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$301.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$230.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$376.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$282.63
|
| Rate for Payer: MVP Health Care of NY Medicare |
$210.84
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$402.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$75.30
|
| Rate for Payer: United Healthcare Commercial |
$402.00
|
| Rate for Payer: United Healthcare Medicare |
$200.80
|
| Rate for Payer: WellCare Medicare |
$276.10
|
|
|
X-RAY EXAM OF THORACIC SPINE 4+ VIEWS
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
HCPCS 72074
|
| Hospital Charge Code |
4150258
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$326.30 |
| Max. Negotiated Rate |
$326.30 |
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: Galaxy Health Commercial |
$326.30
|
|
|
X-RAY EXAM OF THORACIC SPINE, 4+ VIEWS
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
HCPCS 72074 26
|
| Hospital Charge Code |
5150258
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$24.05 |
| Max. Negotiated Rate |
$24.05 |
| Rate for Payer: Cash Price |
$27.75
|
| Rate for Payer: Galaxy Health Commercial |
$24.05
|
|
