|
MRI BRAIN STEM W/DYE
|
Facility
OP
|
$1,864.00
|
|
|
Service Code
|
HCPCS 70552
|
| Hospital Charge Code |
4230029
|
|
Hospital Revenue Code
|
611
|
| 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 |
$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 |
$505.00
|
| 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
|
|
|
MRI BRAIN STEM W/O DYE
|
Facility
OP
|
$2,433.00
|
|
|
Service Code
|
HCPCS 70551 TC
|
| Hospital Charge Code |
4230008
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$794.00 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,119.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,824.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,824.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$900.21
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$1,824.75
|
| Rate for Payer: Cash Price |
$1,824.75
|
| Rate for Payer: Cash Price |
$1,824.75
|
| Rate for Payer: CDPHP Commercial |
$1,958.56
|
| Rate for Payer: CDPHP Medicare |
$900.21
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,946.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,946.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,946.40
|
| Rate for Payer: EmblemHealth Medicare |
$827.22
|
| Rate for Payer: Fidelis Medicare |
$927.22
|
| Rate for Payer: Galaxy Health Commercial |
$1,581.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$900.21
|
| Rate for Payer: Humana Medicare |
$900.21
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,119.18
|
| 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 |
$945.22
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$900.21
|
| Rate for Payer: WellCare Medicare |
$1,338.15
|
|
|
MRI BRAIN STEM W/O & W/DYE
|
Facility
OP
|
$3,779.00
|
|
|
Service Code
|
HCPCS 70553
|
| Hospital Charge Code |
4230009
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$3,042.10 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,738.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,834.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,834.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,398.23
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$2,834.25
|
| Rate for Payer: Cash Price |
$2,834.25
|
| Rate for Payer: Cash Price |
$2,834.25
|
| Rate for Payer: CDPHP Commercial |
$3,042.10
|
| Rate for Payer: CDPHP Medicare |
$1,398.23
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,023.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,023.20
|
| Rate for Payer: EmblemHealth Medicaid |
$3,023.20
|
| Rate for Payer: EmblemHealth Medicare |
$1,284.86
|
| Rate for Payer: Fidelis Medicare |
$1,440.18
|
| Rate for Payer: Galaxy Health Commercial |
$2,456.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,398.23
|
| Rate for Payer: Humana Medicare |
$1,398.23
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,738.34
|
| 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 |
$1,468.14
|
| 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 |
$1,398.23
|
| Rate for Payer: WellCare Medicare |
$2,078.45
|
|
|
MRI, BREAST, W/O CONTRAST; BILAT
|
Facility
OP
|
$701.00
|
|
|
Service Code
|
HCPCS 77047
|
| Hospital Charge Code |
4230212
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$238.34 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$322.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$525.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$525.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$259.37
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$525.75
|
| Rate for Payer: Cash Price |
$525.75
|
| Rate for Payer: Cash Price |
$525.75
|
| Rate for Payer: CDPHP Commercial |
$564.30
|
| Rate for Payer: CDPHP Medicare |
$259.37
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$560.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$560.80
|
| Rate for Payer: EmblemHealth Medicaid |
$560.80
|
| Rate for Payer: EmblemHealth Medicare |
$238.34
|
| Rate for Payer: Fidelis Medicare |
$267.15
|
| Rate for Payer: Galaxy Health Commercial |
$455.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$259.37
|
| Rate for Payer: Humana Medicare |
$259.37
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$322.46
|
| 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 |
$272.34
|
| 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 |
$259.37
|
| Rate for Payer: WellCare Medicare |
$385.55
|
|
|
MRI, BREAST, W/O CONTRAST; UNI
|
Facility
OP
|
$701.00
|
|
|
Service Code
|
HCPCS 77046
|
| Hospital Charge Code |
4230211
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$238.34 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$322.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$525.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$525.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$259.37
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$525.75
|
| Rate for Payer: Cash Price |
$525.75
|
| Rate for Payer: Cash Price |
$525.75
|
| Rate for Payer: CDPHP Commercial |
$564.30
|
| Rate for Payer: CDPHP Medicare |
$259.37
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$560.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$560.80
|
| Rate for Payer: EmblemHealth Medicaid |
$560.80
|
| Rate for Payer: EmblemHealth Medicare |
$238.34
|
| Rate for Payer: Fidelis Medicare |
$267.15
|
| Rate for Payer: Galaxy Health Commercial |
$455.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$259.37
|
| Rate for Payer: Humana Medicare |
$259.37
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$322.46
|
| 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 |
$272.34
|
| 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 |
$259.37
|
| Rate for Payer: WellCare Medicare |
$385.55
|
|
|
MRI CERVICAL SPINE W/DYE
|
Facility
OP
|
$3,779.00
|
|
|
Service Code
|
HCPCS 72142
|
| Hospital Charge Code |
4230030
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$3,042.10 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,738.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,834.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,834.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,398.23
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$2,834.25
|
| Rate for Payer: Cash Price |
$2,834.25
|
| Rate for Payer: Cash Price |
$2,834.25
|
| Rate for Payer: CDPHP Commercial |
$3,042.10
|
| Rate for Payer: CDPHP Medicare |
$1,398.23
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,023.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,023.20
|
| Rate for Payer: EmblemHealth Medicaid |
$3,023.20
|
| Rate for Payer: EmblemHealth Medicare |
$1,284.86
|
| Rate for Payer: Fidelis Medicare |
$1,440.18
|
| Rate for Payer: Galaxy Health Commercial |
$2,456.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,398.23
|
| Rate for Payer: Humana Medicare |
$1,398.23
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,738.34
|
| 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 |
$1,468.14
|
| 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 |
$1,398.23
|
| Rate for Payer: WellCare Medicare |
$2,078.45
|
|
|
MRI CERVICAL SPINE W/O DYE
|
Facility
OP
|
$2,588.00
|
|
|
Service Code
|
HCPCS 72141 TC
|
| Hospital Charge Code |
4230010
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$794.00 |
| 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 Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$957.56
|
| Rate for Payer: WellCare Medicare |
$1,423.40
|
|
|
MRI CERVICAL SPINE W/O & W/DYE
|
Facility
OP
|
$3,779.00
|
|
|
Service Code
|
HCPCS 72156
|
| Hospital Charge Code |
4230011
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$3,042.10 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,738.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,834.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,834.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,398.23
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$2,834.25
|
| Rate for Payer: Cash Price |
$2,834.25
|
| Rate for Payer: Cash Price |
$2,834.25
|
| Rate for Payer: CDPHP Commercial |
$3,042.10
|
| Rate for Payer: CDPHP Medicare |
$1,398.23
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,023.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,023.20
|
| Rate for Payer: EmblemHealth Medicaid |
$3,023.20
|
| Rate for Payer: EmblemHealth Medicare |
$1,284.86
|
| Rate for Payer: Fidelis Medicare |
$1,440.18
|
| Rate for Payer: Galaxy Health Commercial |
$2,456.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,398.23
|
| Rate for Payer: Humana Medicare |
$1,398.23
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,738.34
|
| 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 |
$1,468.14
|
| 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 |
$1,398.23
|
| Rate for Payer: WellCare Medicare |
$2,078.45
|
|
|
MRI CHEST W/DYE
|
Facility
OP
|
$3,106.00
|
|
|
Service Code
|
HCPCS 71551
|
| Hospital Charge Code |
4230028
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$2,500.33 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,428.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,329.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,329.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,149.22
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$2,329.50
|
| Rate for Payer: Cash Price |
$2,329.50
|
| Rate for Payer: Cash Price |
$2,329.50
|
| Rate for Payer: CDPHP Commercial |
$2,500.33
|
| Rate for Payer: CDPHP Medicare |
$1,149.22
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,484.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,484.80
|
| Rate for Payer: EmblemHealth Medicaid |
$2,484.80
|
| Rate for Payer: EmblemHealth Medicare |
$1,056.04
|
| Rate for Payer: Fidelis Medicare |
$1,183.70
|
| Rate for Payer: Galaxy Health Commercial |
$2,018.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,149.22
|
| Rate for Payer: Humana Medicare |
$1,149.22
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,428.76
|
| 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 |
$1,206.68
|
| 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 |
$1,149.22
|
| Rate for Payer: WellCare Medicare |
$1,708.30
|
|
|
MRI CHEST W/O DYE
|
Facility
OP
|
$2,692.00
|
|
|
Service Code
|
HCPCS 71550
|
| Hospital Charge Code |
4230003
|
|
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 CHEST W/O & W/DYE
|
Facility
OP
|
$4,400.00
|
|
|
Service Code
|
HCPCS 71552
|
| Hospital Charge Code |
4230004
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$3,542.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,024.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,300.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3,300.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,628.00
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$3,300.00
|
| Rate for Payer: Cash Price |
$3,300.00
|
| Rate for Payer: Cash Price |
$3,300.00
|
| Rate for Payer: CDPHP Commercial |
$3,542.00
|
| Rate for Payer: CDPHP Medicare |
$1,628.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,520.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,520.00
|
| Rate for Payer: EmblemHealth Medicaid |
$3,520.00
|
| Rate for Payer: EmblemHealth Medicare |
$1,496.00
|
| Rate for Payer: Fidelis Medicare |
$1,676.84
|
| Rate for Payer: Galaxy Health Commercial |
$2,860.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,628.00
|
| Rate for Payer: Humana Medicare |
$1,628.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,024.00
|
| 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 |
$1,709.40
|
| 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 |
$1,628.00
|
| Rate for Payer: WellCare Medicare |
$2,420.00
|
|
|
MRI LOWER EXT; ANY JOINT W/DYE
|
Facility
OP
|
$2,291.00
|
|
|
Service Code
|
HCPCS 73722
|
| Hospital Charge Code |
4230017
|
|
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 |
$1,053.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,718.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,718.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$847.67
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$1,718.25
|
| Rate for Payer: Cash Price |
$1,718.25
|
| Rate for Payer: Cash Price |
$1,718.25
|
| Rate for Payer: CDPHP Commercial |
$1,844.26
|
| Rate for Payer: CDPHP Medicare |
$847.67
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,832.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,832.80
|
| Rate for Payer: EmblemHealth Medicaid |
$1,832.80
|
| Rate for Payer: EmblemHealth Medicare |
$778.94
|
| Rate for Payer: Fidelis Medicare |
$873.10
|
| Rate for Payer: Galaxy Health Commercial |
$1,489.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$847.67
|
| Rate for Payer: Humana Medicare |
$847.67
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,053.86
|
| 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 |
$890.05
|
| 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 |
$847.67
|
| Rate for Payer: WellCare Medicare |
$1,260.05
|
|
|
MRI LOWER EXT; ANY JOINT W/DYE
|
Facility
OP
|
$2,291.00
|
|
|
Service Code
|
HCPCS 73722
|
| Hospital Charge Code |
4230020
|
|
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 |
$1,053.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,718.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,718.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$847.67
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$1,718.25
|
| Rate for Payer: Cash Price |
$1,718.25
|
| Rate for Payer: Cash Price |
$1,718.25
|
| Rate for Payer: CDPHP Commercial |
$1,844.26
|
| Rate for Payer: CDPHP Medicare |
$847.67
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,832.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,832.80
|
| Rate for Payer: EmblemHealth Medicaid |
$1,832.80
|
| Rate for Payer: EmblemHealth Medicare |
$778.94
|
| Rate for Payer: Fidelis Medicare |
$873.10
|
| Rate for Payer: Galaxy Health Commercial |
$1,489.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$847.67
|
| Rate for Payer: Humana Medicare |
$847.67
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,053.86
|
| 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 |
$890.05
|
| 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 |
$847.67
|
| Rate for Payer: WellCare Medicare |
$1,260.05
|
|
|
MRI LOWER EXT; ANY JOINT W/O DYE
|
Facility
OP
|
$2,278.00
|
|
|
Service Code
|
HCPCS 73721 TC
|
| Hospital Charge Code |
4230016
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$774.52 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,047.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,708.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,708.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$842.86
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$1,708.50
|
| Rate for Payer: Cash Price |
$1,708.50
|
| Rate for Payer: Cash Price |
$1,708.50
|
| Rate for Payer: CDPHP Commercial |
$1,833.79
|
| Rate for Payer: CDPHP Medicare |
$842.86
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,822.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,822.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,822.40
|
| Rate for Payer: EmblemHealth Medicare |
$774.52
|
| Rate for Payer: Fidelis Medicare |
$868.15
|
| Rate for Payer: Galaxy Health Commercial |
$1,480.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$842.86
|
| Rate for Payer: Humana Medicare |
$842.86
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,047.88
|
| 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 |
$885.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$842.86
|
| Rate for Payer: WellCare Medicare |
$1,252.90
|
|
|
MRI LOWER EXT; ANY JOINT W/O&W/DYE
|
Facility
OP
|
$3,882.00
|
|
|
Service Code
|
HCPCS 73723
|
| Hospital Charge Code |
4230018
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$3,125.01 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,785.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,911.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,911.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,436.34
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$2,911.50
|
| Rate for Payer: Cash Price |
$2,911.50
|
| Rate for Payer: Cash Price |
$2,911.50
|
| Rate for Payer: CDPHP Commercial |
$3,125.01
|
| Rate for Payer: CDPHP Medicare |
$1,436.34
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,105.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,105.60
|
| Rate for Payer: EmblemHealth Medicaid |
$3,105.60
|
| Rate for Payer: EmblemHealth Medicare |
$1,319.88
|
| Rate for Payer: Fidelis Medicare |
$1,479.43
|
| Rate for Payer: Galaxy Health Commercial |
$2,523.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,436.34
|
| Rate for Payer: Humana Medicare |
$1,436.34
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,785.72
|
| 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 |
$1,508.16
|
| 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 |
$1,436.34
|
| Rate for Payer: WellCare Medicare |
$2,135.10
|
|
|
MRI LOWER EXT; NON JOINT W DYE
|
Facility
OP
|
$2,847.00
|
|
|
Service Code
|
HCPCS 73719
|
| Hospital Charge Code |
4230069
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$505.00 |
| 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 |
$505.00
|
| 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
|
|
|
MRI LOWER EXT; NON JOINT W/O DYE
|
Facility
OP
|
$2,588.00
|
|
|
Service Code
|
HCPCS 73718
|
| Hospital Charge Code |
4230019
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Galaxy Health Commercial |
$1,682.20
|
| 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: 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
|
|
|
MRI LOWER EXT; NON JOINT W/O&W/DYE
|
Facility
OP
|
$4,005.00
|
|
|
Service Code
|
HCPCS 73720
|
| Hospital Charge Code |
4230033
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$3,224.02 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,842.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,003.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3,003.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,481.85
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$3,003.75
|
| Rate for Payer: Cash Price |
$3,003.75
|
| Rate for Payer: Cash Price |
$3,003.75
|
| Rate for Payer: CDPHP Commercial |
$3,224.02
|
| Rate for Payer: CDPHP Medicare |
$1,481.85
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,204.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,204.00
|
| Rate for Payer: EmblemHealth Medicaid |
$3,204.00
|
| Rate for Payer: EmblemHealth Medicare |
$1,361.70
|
| Rate for Payer: Fidelis Medicare |
$1,526.31
|
| Rate for Payer: Galaxy Health Commercial |
$2,603.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,481.85
|
| Rate for Payer: Humana Medicare |
$1,481.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,842.30
|
| 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 |
$1,555.94
|
| 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 |
$1,481.85
|
| Rate for Payer: WellCare Medicare |
$2,202.75
|
|
|
MRI LUMBAR SPINE W/DYE
|
Facility
OP
|
$2,951.00
|
|
|
Service Code
|
HCPCS 72149
|
| Hospital Charge Code |
4230032
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$2,375.56 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,357.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,213.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,213.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,091.87
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$2,213.25
|
| Rate for Payer: Cash Price |
$2,213.25
|
| Rate for Payer: Cash Price |
$2,213.25
|
| Rate for Payer: CDPHP Commercial |
$2,375.56
|
| Rate for Payer: CDPHP Medicare |
$1,091.87
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,360.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,360.80
|
| Rate for Payer: EmblemHealth Medicaid |
$2,360.80
|
| Rate for Payer: EmblemHealth Medicare |
$1,003.34
|
| Rate for Payer: Fidelis Medicare |
$1,124.63
|
| Rate for Payer: Galaxy Health Commercial |
$1,918.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,091.87
|
| Rate for Payer: Humana Medicare |
$1,091.87
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,357.46
|
| 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 |
$1,146.46
|
| 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 |
$1,091.87
|
| Rate for Payer: WellCare Medicare |
$1,623.05
|
|
|
MRI LUMBAR SPINE W/O DYE
|
Facility
OP
|
$2,381.00
|
|
|
Service Code
|
HCPCS 72148 TC
|
| Hospital Charge Code |
4230014
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$794.00 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,095.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,785.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,785.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$880.97
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$1,785.75
|
| Rate for Payer: Cash Price |
$1,785.75
|
| Rate for Payer: Cash Price |
$1,785.75
|
| Rate for Payer: CDPHP Commercial |
$1,916.70
|
| Rate for Payer: CDPHP Medicare |
$880.97
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,904.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,904.80
|
| Rate for Payer: EmblemHealth Medicaid |
$1,904.80
|
| Rate for Payer: EmblemHealth Medicare |
$809.54
|
| Rate for Payer: Fidelis Medicare |
$907.40
|
| Rate for Payer: Galaxy Health Commercial |
$1,547.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$880.97
|
| Rate for Payer: Humana Medicare |
$880.97
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,095.26
|
| 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 |
$925.02
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$880.97
|
| Rate for Payer: WellCare Medicare |
$1,309.55
|
|
|
MRI LUMBAR SPINE W/O & W/DYE
|
Facility
OP
|
$3,882.00
|
|
|
Service Code
|
HCPCS 72158
|
| Hospital Charge Code |
4230015
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$3,125.01 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,785.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,911.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,911.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,436.34
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$2,911.50
|
| Rate for Payer: Cash Price |
$2,911.50
|
| Rate for Payer: Cash Price |
$2,911.50
|
| Rate for Payer: CDPHP Commercial |
$3,125.01
|
| Rate for Payer: CDPHP Medicare |
$1,436.34
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,105.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,105.60
|
| Rate for Payer: EmblemHealth Medicaid |
$3,105.60
|
| Rate for Payer: EmblemHealth Medicare |
$1,319.88
|
| Rate for Payer: Fidelis Medicare |
$1,479.43
|
| Rate for Payer: Galaxy Health Commercial |
$2,523.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,436.34
|
| Rate for Payer: Humana Medicare |
$1,436.34
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,785.72
|
| 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 |
$1,508.16
|
| 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 |
$1,436.34
|
| Rate for Payer: WellCare Medicare |
$2,135.10
|
|
|
MRI OF TMJ(S)
|
Facility
OP
|
$2,847.00
|
|
|
Service Code
|
HCPCS 70336
|
| Hospital Charge Code |
4230040
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$505.00 |
| 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 |
$505.00
|
| 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
|
|
|
MRI ORBIT/FACE/NECK W/DYE
|
Facility
OP
|
$3,779.00
|
|
|
Service Code
|
HCPCS 70542
|
| Hospital Charge Code |
4230042
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$3,042.10 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,738.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,834.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,834.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,398.23
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$2,834.25
|
| Rate for Payer: Cash Price |
$2,834.25
|
| Rate for Payer: Cash Price |
$2,834.25
|
| Rate for Payer: CDPHP Commercial |
$3,042.10
|
| Rate for Payer: CDPHP Medicare |
$1,398.23
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,023.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,023.20
|
| Rate for Payer: EmblemHealth Medicaid |
$3,023.20
|
| Rate for Payer: EmblemHealth Medicare |
$1,284.86
|
| Rate for Payer: Fidelis Medicare |
$1,440.18
|
| Rate for Payer: Galaxy Health Commercial |
$2,456.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,398.23
|
| Rate for Payer: Humana Medicare |
$1,398.23
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,738.34
|
| 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 |
$1,468.14
|
| 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 |
$1,398.23
|
| Rate for Payer: WellCare Medicare |
$2,078.45
|
|
|
MRI ORBIT/FACE/NECK W/O DYE
|
Facility
OP
|
$2,588.00
|
|
|
Service Code
|
HCPCS 70540
|
| Hospital Charge Code |
4230041
|
|
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 |
$1,190.48
|
| 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
|
|
|
MRI ORBT/FAC/NCK W/O &W/DYE
|
Facility
OP
|
$3,903.00
|
|
|
Service Code
|
HCPCS 70543
|
| Hospital Charge Code |
4230043
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$3,141.92 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,795.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,927.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,927.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,444.11
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$2,927.25
|
| Rate for Payer: Cash Price |
$2,927.25
|
| Rate for Payer: Cash Price |
$2,927.25
|
| Rate for Payer: CDPHP Commercial |
$3,141.92
|
| Rate for Payer: CDPHP Medicare |
$1,444.11
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,122.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,122.40
|
| Rate for Payer: EmblemHealth Medicaid |
$3,122.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,327.02
|
| Rate for Payer: Fidelis Medicare |
$1,487.43
|
| Rate for Payer: Galaxy Health Commercial |
$2,536.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,444.11
|
| Rate for Payer: Humana Medicare |
$1,444.11
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,795.38
|
| 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 |
$1,516.32
|
| 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 |
$1,444.11
|
| Rate for Payer: WellCare Medicare |
$2,146.65
|
|
