|
M/PHMTRC ALYS ISH QUANT/SEMIQ MNL EACH MULTIPRB
|
Facility
|
OP
|
$472.00
|
|
|
Service Code
|
HCPCS 88377 TC
|
| Hospital Charge Code |
4008377
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$160.48 |
| Max. Negotiated Rate |
$379.96 |
| Rate for Payer: Aetna of NY Commercial |
$306.80
|
| Rate for Payer: Aetna of NY Medicare |
$217.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$354.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$354.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$174.64
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$236.00
|
| Rate for Payer: Cash Price |
$354.00
|
| Rate for Payer: CDPHP Commercial |
$379.96
|
| Rate for Payer: CDPHP Medicare |
$174.64
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$283.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$377.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$377.60
|
| Rate for Payer: EmblemHealth Medicaid |
$377.60
|
| Rate for Payer: EmblemHealth Medicare |
$160.48
|
| Rate for Payer: EmblemHealth Select Care |
$283.20
|
| Rate for Payer: Fidelis Medicare |
$179.88
|
| Rate for Payer: Galaxy Health Commercial |
$306.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$174.64
|
| Rate for Payer: Humana Medicare |
$174.64
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$306.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$217.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$354.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$265.74
|
| Rate for Payer: MVP Health Care of NY Medicare |
$183.37
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$354.00
|
| Rate for Payer: United Healthcare Commercial |
$354.00
|
| Rate for Payer: United Healthcare Medicare |
$174.64
|
| Rate for Payer: WellCare Medicare |
$259.60
|
|
|
M/PHMTRC ALYS ISH QUANT/SEMIQ MNL EACH MULTIPRB
|
Facility
|
IP
|
$472.00
|
|
|
Service Code
|
HCPCS 88377 TC
|
| Hospital Charge Code |
4008377
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$306.80 |
| Max. Negotiated Rate |
$306.80 |
| Rate for Payer: Cash Price |
$354.00
|
| Rate for Payer: Galaxy Health Commercial |
$306.80
|
|
|
M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL
|
Facility
|
IP
|
$489.00
|
|
|
Service Code
|
HCPCS 88360 TC
|
| Hospital Charge Code |
4008360
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$317.85 |
| Max. Negotiated Rate |
$317.85 |
| Rate for Payer: Cash Price |
$366.75
|
| Rate for Payer: Galaxy Health Commercial |
$317.85
|
|
|
M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL
|
Facility
|
OP
|
$489.00
|
|
|
Service Code
|
HCPCS 88360 TC
|
| Hospital Charge Code |
4008360
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$166.26 |
| Max. Negotiated Rate |
$393.64 |
| Rate for Payer: Aetna of NY Commercial |
$317.85
|
| Rate for Payer: Aetna of NY Medicare |
$224.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$366.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$366.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$180.93
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$244.50
|
| Rate for Payer: Cash Price |
$366.75
|
| Rate for Payer: CDPHP Commercial |
$393.64
|
| Rate for Payer: CDPHP Medicare |
$180.93
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$293.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$391.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$391.20
|
| Rate for Payer: EmblemHealth Medicaid |
$391.20
|
| Rate for Payer: EmblemHealth Medicare |
$166.26
|
| Rate for Payer: EmblemHealth Select Care |
$293.40
|
| Rate for Payer: Fidelis Medicare |
$186.36
|
| Rate for Payer: Galaxy Health Commercial |
$317.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$180.93
|
| Rate for Payer: Humana Medicare |
$180.93
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$317.85
|
| Rate for Payer: Local 1199SEIU Medicare |
$224.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$366.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$275.31
|
| Rate for Payer: MVP Health Care of NY Medicare |
$189.98
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$366.75
|
| Rate for Payer: United Healthcare Commercial |
$366.75
|
| Rate for Payer: United Healthcare Medicare |
$180.93
|
| Rate for Payer: WellCare Medicare |
$268.95
|
|
|
MRA ABDOMEN W/ W/O DYE
|
Facility
|
OP
|
$2,389.00
|
|
|
Service Code
|
HCPCS 74185
|
| Hospital Charge Code |
4230049
|
|
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 CBP/EPO/PPO/HMO/Network Access |
$1,672.30
|
| 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: EmblemHealth Select Care |
$1,552.85
|
| 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 ABDOMEN W/ W/O DYE
|
Facility
|
IP
|
$2,389.00
|
|
|
Service Code
|
HCPCS 74185
|
| Hospital Charge Code |
4230049
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,552.85 |
| Max. Negotiated Rate |
$1,552.85 |
| Rate for Payer: Cash Price |
$1,791.75
|
| Rate for Payer: Galaxy Health Commercial |
$1,552.85
|
|
|
MRA ABD W CONTRAST
|
Facility
|
OP
|
$2,329.00
|
|
|
Service Code
|
HCPCS C8900
|
| Hospital Charge Code |
4230063
|
|
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 |
$1,071.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,746.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,746.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$861.73
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$1,746.75
|
| Rate for Payer: Cash Price |
$1,746.75
|
| Rate for Payer: Cash Price |
$1,746.75
|
| Rate for Payer: CDPHP Commercial |
$1,874.84
|
| Rate for Payer: CDPHP Medicare |
$861.73
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,630.30
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,863.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,863.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,863.20
|
| Rate for Payer: EmblemHealth Medicare |
$791.86
|
| Rate for Payer: EmblemHealth Select Care |
$1,513.85
|
| Rate for Payer: Fidelis Medicare |
$887.58
|
| Rate for Payer: Galaxy Health Commercial |
$1,513.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$861.73
|
| Rate for Payer: Humana Medicare |
$861.73
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,071.34
|
| 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 |
$904.82
|
| 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 |
$861.73
|
| Rate for Payer: WellCare Medicare |
$1,280.95
|
|
|
MRA ABD W CONTRAST
|
Facility
|
IP
|
$2,329.00
|
|
|
Service Code
|
HCPCS C8900
|
| Hospital Charge Code |
4230063
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,513.85 |
| Max. Negotiated Rate |
$1,513.85 |
| Rate for Payer: Cash Price |
$1,746.75
|
| Rate for Payer: Galaxy Health Commercial |
$1,513.85
|
|
|
MRA ABD WO CONTRAST
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C8901
|
| Hospital Charge Code |
4230209
|
|
Hospital Revenue Code
|
619
|
| Min. Negotiated Rate |
$1,110.20 |
| Max. Negotiated Rate |
$1,110.20 |
| Rate for Payer: Cash Price |
$1,281.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,110.20
|
|
|
MRA ABD WO CONTRAST
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C8901
|
| Hospital Charge Code |
4230209
|
|
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 |
$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 CBP/EPO/PPO/HMO/Network Access |
$1,195.60
|
| 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: EmblemHealth Select Care |
$1,110.20
|
| 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 |
$233.47
|
| 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 ABD W/WO CONTRAST
|
Facility
|
IP
|
$2,847.00
|
|
|
Service Code
|
HCPCS C8902
|
| Hospital Charge Code |
4230064
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,850.55 |
| Max. Negotiated Rate |
$1,850.55 |
| Rate for Payer: Cash Price |
$2,135.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,850.55
|
|
|
MRA ABD W/WO CONTRAST
|
Facility
|
OP
|
$2,847.00
|
|
|
Service Code
|
HCPCS C8902
|
| Hospital Charge Code |
4230064
|
|
Hospital Revenue Code
|
618
|
| 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 CBP/EPO/PPO/HMO/Network Access |
$1,992.90
|
| 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: EmblemHealth Select Care |
$1,850.55
|
| 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 CHEST W CONTRAST
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C8909
|
| Hospital Charge Code |
4230074
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,110.20 |
| Max. Negotiated Rate |
$1,110.20 |
| Rate for Payer: Cash Price |
$1,281.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,110.20
|
|
|
MRA CHEST W CONTRAST
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C8909
|
| Hospital Charge Code |
4230074
|
|
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 CBP/EPO/PPO/HMO/Network Access |
$1,195.60
|
| 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: EmblemHealth Select Care |
$1,110.20
|
| 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 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 CBP/EPO/PPO/HMO/Network Access |
$1,340.50
|
| 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: EmblemHealth Select Care |
$1,244.75
|
| 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 WO CONTR
|
Facility
|
IP
|
$1,915.00
|
|
|
Service Code
|
HCPCS C8910
|
| Hospital Charge Code |
4230208
|
|
Hospital Revenue Code
|
619
|
| Min. Negotiated Rate |
$1,244.75 |
| Max. Negotiated Rate |
$1,244.75 |
| Rate for Payer: Cash Price |
$1,436.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,244.75
|
|
|
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 CBP/EPO/PPO/HMO/Network Access |
$1,195.60
|
| 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: EmblemHealth Select Care |
$1,110.20
|
| 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 CHEST W/WO CONTR
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C8911
|
| Hospital Charge Code |
4230073
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,110.20 |
| Max. Negotiated Rate |
$1,110.20 |
| Rate for Payer: Cash Price |
$1,281.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,110.20
|
|
|
MRA HEAD W/DYE
|
Facility
|
IP
|
$2,226.00
|
|
|
Service Code
|
HCPCS 70545
|
| Hospital Charge Code |
4230035
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,446.90 |
| Max. Negotiated Rate |
$1,446.90 |
| Rate for Payer: Cash Price |
$1,669.50
|
| Rate for Payer: Galaxy Health Commercial |
$1,446.90
|
|
|
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 CBP/EPO/PPO/HMO/Network Access |
$1,558.20
|
| 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: EmblemHealth Select Care |
$1,446.90
|
| 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
|
IP
|
$2,620.00
|
|
|
Service Code
|
HCPCS 70544
|
| Hospital Charge Code |
4230034
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,703.00 |
| Max. Negotiated Rate |
$1,703.00 |
| Rate for Payer: Cash Price |
$1,965.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,703.00
|
|
|
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 CBP/EPO/PPO/HMO/Network Access |
$1,834.00
|
| 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: EmblemHealth Select Care |
$1,703.00
|
| 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 CBP/EPO/PPO/HMO/Network Access |
$1,159.20
|
| 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: EmblemHealth Select Care |
$1,076.40
|
| 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 HEAD W/O&W/DYE
|
Facility
|
IP
|
$1,656.00
|
|
|
Service Code
|
HCPCS 70546
|
| Hospital Charge Code |
4230036
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,076.40 |
| Max. Negotiated Rate |
$1,076.40 |
| Rate for Payer: Cash Price |
$1,242.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,076.40
|
|
|
MRA LEXTREM W CONT
|
Facility
|
IP
|
$2,847.00
|
|
|
Service Code
|
HCPCS C8912
|
| Hospital Charge Code |
4230072
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$1,850.55 |
| Max. Negotiated Rate |
$1,850.55 |
| Rate for Payer: Cash Price |
$2,135.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,850.55
|
|
