|
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 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 LEXTREM WO CONTR
|
Facility
|
IP
|
$1,449.00
|
|
|
Service Code
|
HCPCS C8913
|
| Hospital Charge Code |
4230207
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$941.85 |
| Max. Negotiated Rate |
$941.85 |
| Rate for Payer: Cash Price |
$1,086.75
|
| Rate for Payer: Galaxy Health Commercial |
$941.85
|
|
|
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 CBP/EPO/PPO/HMO/Network Access |
$1,014.30
|
| 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: EmblemHealth Select Care |
$941.85
|
| 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 CBP/EPO/PPO/HMO/Network Access |
$2,790.20
|
| 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: EmblemHealth Select Care |
$2,590.90
|
| 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 LEXTREM W/WO CONTR
|
Facility
|
IP
|
$3,986.00
|
|
|
Service Code
|
HCPCS C8914
|
| Hospital Charge Code |
4230068
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$2,590.90 |
| Max. Negotiated Rate |
$2,590.90 |
| Rate for Payer: Cash Price |
$2,989.50
|
| Rate for Payer: Galaxy Health Commercial |
$2,590.90
|
|
|
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 CBP/EPO/PPO/HMO/Network Access |
$1,330.00
|
| 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: EmblemHealth Select Care |
$1,235.00
|
| 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 LWR EXT W OR W/O DYE
|
Facility
|
IP
|
$1,900.00
|
|
|
Service Code
|
HCPCS 73725
|
| Hospital Charge Code |
4230048
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$1,235.00 |
| Max. Negotiated Rate |
$1,235.00 |
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,235.00
|
|
|
MRA NECK W/DYE
|
Facility
|
IP
|
$2,588.00
|
|
|
Service Code
|
HCPCS 70548
|
| Hospital Charge Code |
4230038
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,682.20 |
| Max. Negotiated Rate |
$1,682.20 |
| Rate for Payer: Cash Price |
$1,941.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,682.20
|
|
|
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 CBP/EPO/PPO/HMO/Network Access |
$1,811.60
|
| 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: EmblemHealth Select Care |
$1,682.20
|
| 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 CBP/EPO/PPO/HMO/Network Access |
$1,884.40
|
| 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: EmblemHealth Select Care |
$1,749.80
|
| 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 DYE
|
Facility
|
IP
|
$2,692.00
|
|
|
Service Code
|
HCPCS 70547
|
| Hospital Charge Code |
4230037
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,749.80 |
| Max. Negotiated Rate |
$1,749.80 |
| Rate for Payer: Cash Price |
$2,019.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,749.80
|
|
|
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 CBP/EPO/PPO/HMO/Network Access |
$2,319.10
|
| 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: EmblemHealth Select Care |
$2,153.45
|
| 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
|
|
|
MRA NECK W/O&W/DYE
|
Facility
|
IP
|
$3,313.00
|
|
|
Service Code
|
HCPCS 70549
|
| Hospital Charge Code |
4230039
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$2,153.45 |
| Max. Negotiated Rate |
$2,153.45 |
| Rate for Payer: Cash Price |
$2,484.75
|
| Rate for Payer: Galaxy Health Commercial |
$2,153.45
|
|
|
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 CBP/EPO/PPO/HMO/Network Access |
$940.10
|
| 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: EmblemHealth Select Care |
$872.95
|
| 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
|
|
|
MR ANGIO PELVIS W/O & W/DYE
|
Facility
|
IP
|
$1,343.00
|
|
|
Service Code
|
HCPCS 72198
|
| Hospital Charge Code |
4230046
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$872.95 |
| Max. Negotiated Rate |
$872.95 |
| Rate for Payer: Cash Price |
$1,007.25
|
| Rate for Payer: Galaxy Health Commercial |
$872.95
|
|
|
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 CBP/EPO/PPO/HMO/Network Access |
$2,849.70
|
| 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: EmblemHealth Select Care |
$2,646.15
|
| 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 SPINE W/O&W/DYE
|
Facility
|
IP
|
$4,071.00
|
|
|
Service Code
|
HCPCS 72159
|
| Hospital Charge Code |
4230045
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$2,646.15 |
| Max. Negotiated Rate |
$2,646.15 |
| Rate for Payer: Cash Price |
$3,053.25
|
| Rate for Payer: Galaxy Health Commercial |
$2,646.15
|
|
|
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 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 UPPER EXT W/O&W/DYE
|
Facility
|
IP
|
$2,389.00
|
|
|
Service Code
|
HCPCS 73225
|
| Hospital Charge Code |
4230047
|
|
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 W/DYE SPINAL CANAL
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS C8931
|
| Hospital Charge Code |
4230206
|
|
Hospital Revenue Code
|
619
|
| Min. Negotiated Rate |
$715.00 |
| Max. Negotiated Rate |
$715.00 |
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Galaxy Health Commercial |
$715.00
|
|
|
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 CBP/EPO/PPO/HMO/Network Access |
$770.00
|
| 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: EmblemHealth Select Care |
$715.00
|
| 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
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS C8934
|
| Hospital Charge Code |
4230205
|
|
Hospital Revenue Code
|
619
|
| Min. Negotiated Rate |
$715.00 |
| Max. Negotiated Rate |
$715.00 |
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Galaxy Health Commercial |
$715.00
|
|
|
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 CBP/EPO/PPO/HMO/Network Access |
$770.00
|
| 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: EmblemHealth Select Care |
$715.00
|
| 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 CBP/EPO/PPO/HMO/Network Access |
$1,304.80
|
| 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: EmblemHealth Select Care |
$1,211.60
|
| 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 SPINAL CANAL
|
Facility
|
IP
|
$1,864.00
|
|
|
Service Code
|
HCPCS C8932
|
| Hospital Charge Code |
4230234
|
|
Hospital Revenue Code
|
619
|
| Min. Negotiated Rate |
$1,211.60 |
| Max. Negotiated Rate |
$1,211.60 |
| Rate for Payer: Cash Price |
$1,398.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,211.60
|
|
