|
MRA CHEST WO CONTR
|
Facility
OP
|
$1,915.00
|
|
|
Service Code
|
HCPCS C8910
|
| Hospital Charge Code |
4230208
|
|
Hospital Revenue Code
|
619
|
| Min. Negotiated Rate |
$233.47 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$880.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,436.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,436.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$708.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$1,436.25
|
| Rate for Payer: Cash Price |
$1,436.25
|
| Rate for Payer: Cash Price |
$1,436.25
|
| Rate for Payer: CDPHP Commercial |
$1,541.58
|
| Rate for Payer: CDPHP Medicare |
$708.55
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,532.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,532.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,532.00
|
| Rate for Payer: EmblemHealth Medicare |
$651.10
|
| Rate for Payer: Fidelis Medicare |
$729.81
|
| Rate for Payer: Galaxy Health Commercial |
$1,244.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$708.55
|
| Rate for Payer: Humana Medicare |
$708.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$880.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$743.98
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$233.47
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$708.55
|
| Rate for Payer: WellCare Medicare |
$1,053.25
|
|
|
MRA CHEST W/WO CONTR
|
Facility
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C8911
|
| Hospital Charge Code |
4230073
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$366.42 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$785.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,281.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,281.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$631.96
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$1,281.00
|
| Rate for Payer: Cash Price |
$1,281.00
|
| Rate for Payer: Cash Price |
$1,281.00
|
| Rate for Payer: CDPHP Commercial |
$1,374.94
|
| Rate for Payer: CDPHP Medicare |
$631.96
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,366.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,366.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,366.40
|
| Rate for Payer: EmblemHealth Medicare |
$580.72
|
| Rate for Payer: Fidelis Medicare |
$650.92
|
| Rate for Payer: Galaxy Health Commercial |
$1,110.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$631.96
|
| Rate for Payer: Humana Medicare |
$631.96
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$785.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$663.56
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$366.42
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$631.96
|
| Rate for Payer: WellCare Medicare |
$939.40
|
|
|
MRA HEAD W/DYE
|
Facility
OP
|
$2,226.00
|
|
|
Service Code
|
HCPCS 70545
|
| Hospital Charge Code |
4230035
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,023.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,669.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,669.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$823.62
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$1,669.50
|
| Rate for Payer: Cash Price |
$1,669.50
|
| Rate for Payer: Cash Price |
$1,669.50
|
| Rate for Payer: CDPHP Commercial |
$1,791.93
|
| Rate for Payer: CDPHP Medicare |
$823.62
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,780.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,780.80
|
| Rate for Payer: EmblemHealth Medicaid |
$1,780.80
|
| Rate for Payer: EmblemHealth Medicare |
$756.84
|
| Rate for Payer: Fidelis Medicare |
$848.33
|
| Rate for Payer: Galaxy Health Commercial |
$1,446.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$823.62
|
| Rate for Payer: Humana Medicare |
$823.62
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,023.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$864.80
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$505.00
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$823.62
|
| Rate for Payer: WellCare Medicare |
$1,224.30
|
|
|
MRA HEAD W/O DYE
|
Facility
OP
|
$2,620.00
|
|
|
Service Code
|
HCPCS 70544
|
| Hospital Charge Code |
4230034
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,205.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,965.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,965.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$969.40
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$1,965.00
|
| Rate for Payer: Cash Price |
$1,965.00
|
| Rate for Payer: Cash Price |
$1,965.00
|
| Rate for Payer: CDPHP Commercial |
$2,109.10
|
| Rate for Payer: CDPHP Medicare |
$969.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,096.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,096.00
|
| Rate for Payer: EmblemHealth Medicaid |
$2,096.00
|
| Rate for Payer: EmblemHealth Medicare |
$890.80
|
| Rate for Payer: Fidelis Medicare |
$998.48
|
| Rate for Payer: Galaxy Health Commercial |
$1,703.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$969.40
|
| Rate for Payer: Humana Medicare |
$969.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,205.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,017.87
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$505.00
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$969.40
|
| Rate for Payer: WellCare Medicare |
$1,441.00
|
|
|
MRA HEAD W/O&W/DYE
|
Facility
OP
|
$1,656.00
|
|
|
Service Code
|
HCPCS 70546
|
| Hospital Charge Code |
4230036
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$761.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,242.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,242.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$612.72
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$1,242.00
|
| Rate for Payer: Cash Price |
$1,242.00
|
| Rate for Payer: Cash Price |
$1,242.00
|
| Rate for Payer: CDPHP Commercial |
$1,333.08
|
| Rate for Payer: CDPHP Medicare |
$612.72
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,324.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,324.80
|
| Rate for Payer: EmblemHealth Medicaid |
$1,324.80
|
| Rate for Payer: EmblemHealth Medicare |
$563.04
|
| Rate for Payer: Fidelis Medicare |
$631.10
|
| Rate for Payer: Galaxy Health Commercial |
$1,076.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$612.72
|
| Rate for Payer: Humana Medicare |
$612.72
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$761.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$643.36
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$505.00
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$612.72
|
| Rate for Payer: WellCare Medicare |
$910.80
|
|
|
MRA LEXTREM W CONT
|
Facility
OP
|
$2,847.00
|
|
|
Service Code
|
HCPCS C8912
|
| Hospital Charge Code |
4230072
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$366.42 |
| Max. Negotiated Rate |
$2,291.84 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,309.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,135.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,135.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,053.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$2,135.25
|
| Rate for Payer: Cash Price |
$2,135.25
|
| Rate for Payer: Cash Price |
$2,135.25
|
| Rate for Payer: CDPHP Commercial |
$2,291.84
|
| Rate for Payer: CDPHP Medicare |
$1,053.39
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,277.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,277.60
|
| Rate for Payer: EmblemHealth Medicaid |
$2,277.60
|
| Rate for Payer: EmblemHealth Medicare |
$967.98
|
| Rate for Payer: Fidelis Medicare |
$1,084.99
|
| Rate for Payer: Galaxy Health Commercial |
$1,850.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,053.39
|
| Rate for Payer: Humana Medicare |
$1,053.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,309.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,106.06
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$366.42
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$1,053.39
|
| Rate for Payer: WellCare Medicare |
$1,565.85
|
|
|
MRA LEXTREM WO CONTR
|
Facility
OP
|
$1,449.00
|
|
|
Service Code
|
HCPCS C8913
|
| Hospital Charge Code |
4230207
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$233.47 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$666.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,086.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,086.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$536.13
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$1,086.75
|
| Rate for Payer: Cash Price |
$1,086.75
|
| Rate for Payer: Cash Price |
$1,086.75
|
| Rate for Payer: CDPHP Commercial |
$1,166.44
|
| Rate for Payer: CDPHP Medicare |
$536.13
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,159.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,159.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,159.20
|
| Rate for Payer: EmblemHealth Medicare |
$492.66
|
| Rate for Payer: Fidelis Medicare |
$552.21
|
| Rate for Payer: Galaxy Health Commercial |
$941.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$536.13
|
| Rate for Payer: Humana Medicare |
$536.13
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$666.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$562.94
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$233.47
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$536.13
|
| Rate for Payer: WellCare Medicare |
$796.95
|
|
|
MRA LEXTREM W/WO CONTR
|
Facility
OP
|
$3,986.00
|
|
|
Service Code
|
HCPCS C8914
|
| Hospital Charge Code |
4230068
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$366.42 |
| Max. Negotiated Rate |
$3,208.73 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,833.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,989.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,989.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,474.82
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$2,989.50
|
| Rate for Payer: Cash Price |
$2,989.50
|
| Rate for Payer: Cash Price |
$2,989.50
|
| Rate for Payer: CDPHP Commercial |
$3,208.73
|
| Rate for Payer: CDPHP Medicare |
$1,474.82
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,188.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,188.80
|
| Rate for Payer: EmblemHealth Medicaid |
$3,188.80
|
| Rate for Payer: EmblemHealth Medicare |
$1,355.24
|
| Rate for Payer: Fidelis Medicare |
$1,519.06
|
| Rate for Payer: Galaxy Health Commercial |
$2,590.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,474.82
|
| Rate for Payer: Humana Medicare |
$1,474.82
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,833.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,548.56
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$366.42
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$1,474.82
|
| Rate for Payer: WellCare Medicare |
$2,192.30
|
|
|
MRA LWR EXT W OR W/O DYE
|
Facility
OP
|
$1,900.00
|
|
|
Service Code
|
HCPCS 73725
|
| Hospital Charge Code |
4230048
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$874.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,425.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,425.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$703.00
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: CDPHP Commercial |
$1,529.50
|
| Rate for Payer: CDPHP Medicare |
$703.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,520.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,520.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,520.00
|
| Rate for Payer: EmblemHealth Medicare |
$646.00
|
| Rate for Payer: Fidelis Medicare |
$724.09
|
| Rate for Payer: Galaxy Health Commercial |
$1,235.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$703.00
|
| Rate for Payer: Humana Medicare |
$703.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$874.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$738.15
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$505.00
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$703.00
|
| Rate for Payer: WellCare Medicare |
$1,045.00
|
|
|
MRA NECK W/DYE
|
Facility
OP
|
$2,588.00
|
|
|
Service Code
|
HCPCS 70548
|
| Hospital Charge Code |
4230038
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,190.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,941.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,941.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$957.56
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$1,941.00
|
| Rate for Payer: Cash Price |
$1,941.00
|
| Rate for Payer: Cash Price |
$1,941.00
|
| Rate for Payer: CDPHP Commercial |
$2,083.34
|
| Rate for Payer: CDPHP Medicare |
$957.56
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,070.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,070.40
|
| Rate for Payer: EmblemHealth Medicaid |
$2,070.40
|
| Rate for Payer: EmblemHealth Medicare |
$879.92
|
| Rate for Payer: Fidelis Medicare |
$986.29
|
| Rate for Payer: Galaxy Health Commercial |
$1,682.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$957.56
|
| Rate for Payer: Humana Medicare |
$957.56
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,190.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,005.44
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$505.00
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$957.56
|
| Rate for Payer: WellCare Medicare |
$1,423.40
|
|
|
MRA NECK W/O DYE
|
Facility
OP
|
$2,692.00
|
|
|
Service Code
|
HCPCS 70547
|
| Hospital Charge Code |
4230037
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,238.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,019.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,019.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$996.04
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$2,019.00
|
| Rate for Payer: Cash Price |
$2,019.00
|
| Rate for Payer: Cash Price |
$2,019.00
|
| Rate for Payer: CDPHP Commercial |
$2,167.06
|
| Rate for Payer: CDPHP Medicare |
$996.04
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,153.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,153.60
|
| Rate for Payer: EmblemHealth Medicaid |
$2,153.60
|
| Rate for Payer: EmblemHealth Medicare |
$915.28
|
| Rate for Payer: Fidelis Medicare |
$1,025.92
|
| Rate for Payer: Galaxy Health Commercial |
$1,749.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$996.04
|
| Rate for Payer: Humana Medicare |
$996.04
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,238.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,045.84
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$505.00
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$996.04
|
| Rate for Payer: WellCare Medicare |
$1,480.60
|
|
|
MRA NECK W/O&W/DYE
|
Facility
OP
|
$3,313.00
|
|
|
Service Code
|
HCPCS 70549
|
| Hospital Charge Code |
4230039
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$2,666.96 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,523.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,484.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,484.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,225.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$2,484.75
|
| Rate for Payer: Cash Price |
$2,484.75
|
| Rate for Payer: Cash Price |
$2,484.75
|
| Rate for Payer: CDPHP Commercial |
$2,666.96
|
| Rate for Payer: CDPHP Medicare |
$1,225.81
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,650.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,650.40
|
| Rate for Payer: EmblemHealth Medicaid |
$2,650.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,126.42
|
| Rate for Payer: Fidelis Medicare |
$1,262.58
|
| Rate for Payer: Galaxy Health Commercial |
$2,153.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,225.81
|
| Rate for Payer: Humana Medicare |
$1,225.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,523.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,287.10
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$505.00
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$1,225.81
|
| Rate for Payer: WellCare Medicare |
$1,822.15
|
|
|
MR ANGIO PELVIS W/O & W/DYE
|
Facility
OP
|
$1,343.00
|
|
|
Service Code
|
HCPCS 72198
|
| Hospital Charge Code |
4230046
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$456.62 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$617.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,007.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,007.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$496.91
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$1,007.25
|
| Rate for Payer: Cash Price |
$1,007.25
|
| Rate for Payer: Cash Price |
$1,007.25
|
| Rate for Payer: CDPHP Commercial |
$1,081.12
|
| Rate for Payer: CDPHP Medicare |
$496.91
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,074.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,074.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,074.40
|
| Rate for Payer: EmblemHealth Medicare |
$456.62
|
| Rate for Payer: Fidelis Medicare |
$511.82
|
| Rate for Payer: Galaxy Health Commercial |
$872.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$496.91
|
| Rate for Payer: Humana Medicare |
$496.91
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$617.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$521.76
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$505.00
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$496.91
|
| Rate for Payer: WellCare Medicare |
$738.65
|
|
|
MRA SPINE W/O&W/DYE
|
Facility
OP
|
$4,071.00
|
|
|
Service Code
|
HCPCS 72159
|
| Hospital Charge Code |
4230045
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$3,277.16 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,872.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,053.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3,053.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,506.27
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$3,053.25
|
| Rate for Payer: Cash Price |
$3,053.25
|
| Rate for Payer: Cash Price |
$3,053.25
|
| Rate for Payer: CDPHP Commercial |
$3,277.16
|
| Rate for Payer: CDPHP Medicare |
$1,506.27
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,256.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,256.80
|
| Rate for Payer: EmblemHealth Medicaid |
$3,256.80
|
| Rate for Payer: EmblemHealth Medicare |
$1,384.14
|
| Rate for Payer: Fidelis Medicare |
$1,551.46
|
| Rate for Payer: Galaxy Health Commercial |
$2,646.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,506.27
|
| Rate for Payer: Humana Medicare |
$1,506.27
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,872.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,581.58
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$505.00
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$1,506.27
|
| Rate for Payer: WellCare Medicare |
$2,239.05
|
|
|
MRA UPPER EXT W/O&W/DYE
|
Facility
OP
|
$2,389.00
|
|
|
Service Code
|
HCPCS 73225
|
| Hospital Charge Code |
4230047
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,098.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,791.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,791.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$883.93
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$1,791.75
|
| Rate for Payer: Cash Price |
$1,791.75
|
| Rate for Payer: Cash Price |
$1,791.75
|
| Rate for Payer: CDPHP Commercial |
$1,923.14
|
| Rate for Payer: CDPHP Medicare |
$883.93
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,911.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,911.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,911.20
|
| Rate for Payer: EmblemHealth Medicare |
$812.26
|
| Rate for Payer: Fidelis Medicare |
$910.45
|
| Rate for Payer: Galaxy Health Commercial |
$1,552.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$883.93
|
| Rate for Payer: Humana Medicare |
$883.93
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,098.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$928.13
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$505.00
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$883.93
|
| Rate for Payer: WellCare Medicare |
$1,313.95
|
|
|
MRA W/DYE SPINAL CANAL
|
Facility
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS C8931
|
| Hospital Charge Code |
4230206
|
|
Hospital Revenue Code
|
619
|
| Min. Negotiated Rate |
$366.42 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$506.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$825.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$825.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$407.00
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: CDPHP Commercial |
$885.50
|
| Rate for Payer: CDPHP Medicare |
$407.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$880.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$880.00
|
| Rate for Payer: EmblemHealth Medicaid |
$880.00
|
| Rate for Payer: EmblemHealth Medicare |
$374.00
|
| Rate for Payer: Fidelis Medicare |
$419.21
|
| Rate for Payer: Galaxy Health Commercial |
$715.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$407.00
|
| Rate for Payer: Humana Medicare |
$407.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$506.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$427.35
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$366.42
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$407.00
|
| Rate for Payer: WellCare Medicare |
$605.00
|
|
|
MRA W/DYE UPPER EXTREMITY
|
Facility
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS C8934
|
| Hospital Charge Code |
4230205
|
|
Hospital Revenue Code
|
619
|
| Min. Negotiated Rate |
$366.42 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$506.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$825.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$825.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$407.00
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: CDPHP Commercial |
$885.50
|
| Rate for Payer: CDPHP Medicare |
$407.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$880.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$880.00
|
| Rate for Payer: EmblemHealth Medicaid |
$880.00
|
| Rate for Payer: EmblemHealth Medicare |
$374.00
|
| Rate for Payer: Fidelis Medicare |
$419.21
|
| Rate for Payer: Galaxy Health Commercial |
$715.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$407.00
|
| Rate for Payer: Humana Medicare |
$407.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$506.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$427.35
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$366.42
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$407.00
|
| Rate for Payer: WellCare Medicare |
$605.00
|
|
|
MRA W/O DYE SPINAL CANAL
|
Facility
OP
|
$1,864.00
|
|
|
Service Code
|
HCPCS C8932
|
| Hospital Charge Code |
4230234
|
|
Hospital Revenue Code
|
619
|
| Min. Negotiated Rate |
$233.47 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$857.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,398.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,398.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$689.68
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$1,398.00
|
| Rate for Payer: Cash Price |
$1,398.00
|
| Rate for Payer: Cash Price |
$1,398.00
|
| Rate for Payer: CDPHP Commercial |
$1,500.52
|
| Rate for Payer: CDPHP Medicare |
$689.68
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,491.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,491.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,491.20
|
| Rate for Payer: EmblemHealth Medicare |
$633.76
|
| Rate for Payer: Fidelis Medicare |
$710.37
|
| Rate for Payer: Galaxy Health Commercial |
$1,211.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$689.68
|
| Rate for Payer: Humana Medicare |
$689.68
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$857.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$724.16
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$233.47
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$689.68
|
| Rate for Payer: WellCare Medicare |
$1,025.20
|
|
|
MRA W/O DYE UPPER EXTR
|
Facility
OP
|
$1,812.00
|
|
|
Service Code
|
HCPCS C8935
|
| Hospital Charge Code |
4230203
|
|
Hospital Revenue Code
|
619
|
| Min. Negotiated Rate |
$233.47 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$833.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,359.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,359.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$670.44
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: CDPHP Commercial |
$1,458.66
|
| Rate for Payer: CDPHP Medicare |
$670.44
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,449.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,449.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,449.60
|
| Rate for Payer: EmblemHealth Medicare |
$616.08
|
| Rate for Payer: Fidelis Medicare |
$690.55
|
| Rate for Payer: Galaxy Health Commercial |
$1,177.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$670.44
|
| Rate for Payer: Humana Medicare |
$670.44
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$833.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$703.96
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$233.47
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$670.44
|
| Rate for Payer: WellCare Medicare |
$996.60
|
|
|
MRA W/O&W/DYE SPINAL CANAL
|
Facility
OP
|
$2,071.00
|
|
|
Service Code
|
HCPCS C8933
|
| Hospital Charge Code |
4230202
|
|
Hospital Revenue Code
|
619
|
| Min. Negotiated Rate |
$366.42 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$952.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,553.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,553.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$766.27
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$1,553.25
|
| Rate for Payer: Cash Price |
$1,553.25
|
| Rate for Payer: Cash Price |
$1,553.25
|
| Rate for Payer: CDPHP Commercial |
$1,667.16
|
| Rate for Payer: CDPHP Medicare |
$766.27
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,656.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,656.80
|
| Rate for Payer: EmblemHealth Medicaid |
$1,656.80
|
| Rate for Payer: EmblemHealth Medicare |
$704.14
|
| Rate for Payer: Fidelis Medicare |
$789.26
|
| Rate for Payer: Galaxy Health Commercial |
$1,346.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$766.27
|
| Rate for Payer: Humana Medicare |
$766.27
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$952.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$804.58
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$366.42
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$766.27
|
| Rate for Payer: WellCare Medicare |
$1,139.05
|
|
|
MRA W/O&W/DYE UPPER EXTR
|
Facility
OP
|
$2,174.00
|
|
|
Service Code
|
HCPCS C8936
|
| Hospital Charge Code |
4230201
|
|
Hospital Revenue Code
|
619
|
| Min. Negotiated Rate |
$366.42 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,000.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,630.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,630.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$804.38
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$1,630.50
|
| Rate for Payer: Cash Price |
$1,630.50
|
| Rate for Payer: Cash Price |
$1,630.50
|
| Rate for Payer: CDPHP Commercial |
$1,750.07
|
| Rate for Payer: CDPHP Medicare |
$804.38
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,739.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,739.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,739.20
|
| Rate for Payer: EmblemHealth Medicare |
$739.16
|
| Rate for Payer: Fidelis Medicare |
$828.51
|
| Rate for Payer: Galaxy Health Commercial |
$1,413.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$804.38
|
| Rate for Payer: Humana Medicare |
$804.38
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,000.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$844.60
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$366.42
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$804.38
|
| Rate for Payer: WellCare Medicare |
$1,195.70
|
|
|
MRI ABDOMEN W/DYE
|
Facility
OP
|
$2,071.00
|
|
|
Service Code
|
HCPCS 74182
|
| Hospital Charge Code |
4230027
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$952.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,553.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,553.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$766.27
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$1,553.25
|
| Rate for Payer: Cash Price |
$1,553.25
|
| Rate for Payer: Cash Price |
$1,553.25
|
| Rate for Payer: CDPHP Commercial |
$1,667.16
|
| Rate for Payer: CDPHP Medicare |
$766.27
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,656.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,656.80
|
| Rate for Payer: EmblemHealth Medicaid |
$1,656.80
|
| Rate for Payer: EmblemHealth Medicare |
$704.14
|
| Rate for Payer: Fidelis Medicare |
$789.26
|
| Rate for Payer: Galaxy Health Commercial |
$1,346.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$766.27
|
| Rate for Payer: Humana Medicare |
$766.27
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$952.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$804.58
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$505.00
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$766.27
|
| Rate for Payer: WellCare Medicare |
$1,139.05
|
|
|
MRI ABDOMEN W/O DYE
|
Facility
OP
|
$2,692.00
|
|
|
Service Code
|
HCPCS 74181
|
| Hospital Charge Code |
4230001
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,238.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,019.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,019.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$996.04
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$2,019.00
|
| Rate for Payer: Cash Price |
$2,019.00
|
| Rate for Payer: Cash Price |
$2,019.00
|
| Rate for Payer: CDPHP Commercial |
$2,167.06
|
| Rate for Payer: CDPHP Medicare |
$996.04
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,153.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,153.60
|
| Rate for Payer: EmblemHealth Medicaid |
$2,153.60
|
| Rate for Payer: EmblemHealth Medicare |
$915.28
|
| Rate for Payer: Fidelis Medicare |
$1,025.92
|
| Rate for Payer: Galaxy Health Commercial |
$1,749.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$996.04
|
| Rate for Payer: Humana Medicare |
$996.04
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,238.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,045.84
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$505.00
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$996.04
|
| Rate for Payer: WellCare Medicare |
$1,480.60
|
|
|
MRI ABDOMEN W/O & W/DYE
|
Facility
OP
|
$4,096.00
|
|
|
Service Code
|
HCPCS 74183
|
| Hospital Charge Code |
4230002
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$3,297.28 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,884.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,072.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3,072.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,515.52
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$3,072.00
|
| Rate for Payer: Cash Price |
$3,072.00
|
| Rate for Payer: Cash Price |
$3,072.00
|
| Rate for Payer: CDPHP Commercial |
$3,297.28
|
| Rate for Payer: CDPHP Medicare |
$1,515.52
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,276.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,276.80
|
| Rate for Payer: EmblemHealth Medicaid |
$3,276.80
|
| Rate for Payer: EmblemHealth Medicare |
$1,392.64
|
| Rate for Payer: Fidelis Medicare |
$1,560.99
|
| Rate for Payer: Galaxy Health Commercial |
$2,662.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,515.52
|
| Rate for Payer: Humana Medicare |
$1,515.52
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,884.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,591.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$505.00
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$1,515.52
|
| Rate for Payer: WellCare Medicare |
$2,252.80
|
|
|
MRI ANGIO CHEST W OR W/O DYE
|
Facility
OP
|
$2,324.00
|
|
|
Service Code
|
HCPCS 71555
|
| Hospital Charge Code |
4230044
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,069.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,743.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,743.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$859.88
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$1,743.00
|
| Rate for Payer: Cash Price |
$1,743.00
|
| Rate for Payer: Cash Price |
$1,743.00
|
| Rate for Payer: CDPHP Commercial |
$1,870.82
|
| Rate for Payer: CDPHP Medicare |
$859.88
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,859.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,859.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,859.20
|
| Rate for Payer: EmblemHealth Medicare |
$790.16
|
| Rate for Payer: Fidelis Medicare |
$885.68
|
| Rate for Payer: Galaxy Health Commercial |
$1,510.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$859.88
|
| Rate for Payer: Humana Medicare |
$859.88
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,069.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$902.87
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$505.00
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$859.88
|
| Rate for Payer: WellCare Medicare |
$1,278.20
|
|
