|
MRA W/O DYE UPPER EXTR
|
Facility
|
OP
|
$1,812.00
|
|
|
Service Code
|
HCPCS C8935
|
| Hospital Charge Code |
4230203
|
|
Hospital Revenue Code
|
619
|
| Min. Negotiated Rate |
$233.47 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$833.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,359.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,359.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$670.44
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: CDPHP Commercial |
$1,458.66
|
| Rate for Payer: CDPHP Medicare |
$670.44
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,268.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,449.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,449.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,449.60
|
| Rate for Payer: EmblemHealth Medicare |
$616.08
|
| Rate for Payer: EmblemHealth Select Care |
$1,177.80
|
| Rate for Payer: Fidelis Medicare |
$690.55
|
| Rate for Payer: Galaxy Health Commercial |
$1,177.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$670.44
|
| Rate for Payer: Humana Medicare |
$670.44
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$833.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$703.96
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$233.47
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$670.44
|
| Rate for Payer: WellCare Medicare |
$996.60
|
|
|
MRA W/O DYE UPPER EXTR
|
Facility
|
IP
|
$1,812.00
|
|
|
Service Code
|
HCPCS C8935
|
| Hospital Charge Code |
4230203
|
|
Hospital Revenue Code
|
619
|
| Min. Negotiated Rate |
$1,177.80 |
| Max. Negotiated Rate |
$1,177.80 |
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,177.80
|
|
|
MRA W/O&W/DYE SPINAL CANAL
|
Facility
|
IP
|
$2,071.00
|
|
|
Service Code
|
HCPCS C8933
|
| Hospital Charge Code |
4230202
|
|
Hospital Revenue Code
|
619
|
| Min. Negotiated Rate |
$1,346.15 |
| Max. Negotiated Rate |
$1,346.15 |
| Rate for Payer: Cash Price |
$1,553.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,346.15
|
|
|
MRA W/O&W/DYE SPINAL CANAL
|
Facility
|
OP
|
$2,071.00
|
|
|
Service Code
|
HCPCS C8933
|
| Hospital Charge Code |
4230202
|
|
Hospital Revenue Code
|
619
|
| Min. Negotiated Rate |
$366.42 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$952.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,553.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,553.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$766.27
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$1,553.25
|
| Rate for Payer: Cash Price |
$1,553.25
|
| Rate for Payer: Cash Price |
$1,553.25
|
| Rate for Payer: CDPHP Commercial |
$1,667.16
|
| Rate for Payer: CDPHP Medicare |
$766.27
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,449.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,656.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,656.80
|
| Rate for Payer: EmblemHealth Medicaid |
$1,656.80
|
| Rate for Payer: EmblemHealth Medicare |
$704.14
|
| Rate for Payer: EmblemHealth Select Care |
$1,346.15
|
| Rate for Payer: Fidelis Medicare |
$789.26
|
| Rate for Payer: Galaxy Health Commercial |
$1,346.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$766.27
|
| Rate for Payer: Humana Medicare |
$766.27
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$952.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$804.58
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$366.42
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$766.27
|
| Rate for Payer: WellCare Medicare |
$1,139.05
|
|
|
MRA W/O&W/DYE UPPER EXTR
|
Facility
|
OP
|
$2,174.00
|
|
|
Service Code
|
HCPCS C8936
|
| Hospital Charge Code |
4230201
|
|
Hospital Revenue Code
|
619
|
| Min. Negotiated Rate |
$366.42 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,000.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,630.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,630.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$804.38
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$1,630.50
|
| Rate for Payer: Cash Price |
$1,630.50
|
| Rate for Payer: Cash Price |
$1,630.50
|
| Rate for Payer: CDPHP Commercial |
$1,750.07
|
| Rate for Payer: CDPHP Medicare |
$804.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,521.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,739.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,739.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,739.20
|
| Rate for Payer: EmblemHealth Medicare |
$739.16
|
| Rate for Payer: EmblemHealth Select Care |
$1,413.10
|
| Rate for Payer: Fidelis Medicare |
$828.51
|
| Rate for Payer: Galaxy Health Commercial |
$1,413.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$804.38
|
| Rate for Payer: Humana Medicare |
$804.38
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,000.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$844.60
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$366.42
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$804.38
|
| Rate for Payer: WellCare Medicare |
$1,195.70
|
|
|
MRA W/O&W/DYE UPPER EXTR
|
Facility
|
IP
|
$2,174.00
|
|
|
Service Code
|
HCPCS C8936
|
| Hospital Charge Code |
4230201
|
|
Hospital Revenue Code
|
619
|
| Min. Negotiated Rate |
$1,413.10 |
| Max. Negotiated Rate |
$1,413.10 |
| Rate for Payer: Cash Price |
$1,630.50
|
| Rate for Payer: Galaxy Health Commercial |
$1,413.10
|
|
|
MRI ABDOMEN W/DYE
|
Facility
|
OP
|
$2,071.00
|
|
|
Service Code
|
HCPCS 74182
|
| Hospital Charge Code |
4230027
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$952.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,553.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,553.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$766.27
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$1,553.25
|
| Rate for Payer: Cash Price |
$1,553.25
|
| Rate for Payer: Cash Price |
$1,553.25
|
| Rate for Payer: CDPHP Commercial |
$1,667.16
|
| Rate for Payer: CDPHP Medicare |
$766.27
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,449.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,656.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,656.80
|
| Rate for Payer: EmblemHealth Medicaid |
$1,656.80
|
| Rate for Payer: EmblemHealth Medicare |
$704.14
|
| Rate for Payer: EmblemHealth Select Care |
$1,346.15
|
| Rate for Payer: Fidelis Medicare |
$789.26
|
| Rate for Payer: Galaxy Health Commercial |
$1,346.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$766.27
|
| Rate for Payer: Humana Medicare |
$766.27
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$952.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$804.58
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$505.00
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$766.27
|
| Rate for Payer: WellCare Medicare |
$1,139.05
|
|
|
MRI ABDOMEN W/DYE
|
Facility
|
IP
|
$2,071.00
|
|
|
Service Code
|
HCPCS 74182
|
| Hospital Charge Code |
4230027
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,346.15 |
| Max. Negotiated Rate |
$1,346.15 |
| Rate for Payer: Cash Price |
$1,553.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,346.15
|
|
|
MRI ABDOMEN W/O DYE
|
Facility
|
OP
|
$2,692.00
|
|
|
Service Code
|
HCPCS 74181
|
| Hospital Charge Code |
4230001
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,238.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,019.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,019.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$996.04
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$2,019.00
|
| Rate for Payer: Cash Price |
$2,019.00
|
| Rate for Payer: Cash Price |
$2,019.00
|
| Rate for Payer: CDPHP Commercial |
$2,167.06
|
| Rate for Payer: CDPHP Medicare |
$996.04
|
| Rate for Payer: EmblemHealth 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
|
|
|
MRI ABDOMEN W/O DYE
|
Facility
|
IP
|
$2,692.00
|
|
|
Service Code
|
HCPCS 74181
|
| Hospital Charge Code |
4230001
|
|
Hospital Revenue Code
|
610
|
| 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
|
|
|
MRI ABDOMEN W/O & W/DYE
|
Facility
|
OP
|
$4,096.00
|
|
|
Service Code
|
HCPCS 74183
|
| Hospital Charge Code |
4230002
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$3,297.28 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,884.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,072.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3,072.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,515.52
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$3,072.00
|
| Rate for Payer: Cash Price |
$3,072.00
|
| Rate for Payer: Cash Price |
$3,072.00
|
| Rate for Payer: CDPHP Commercial |
$3,297.28
|
| Rate for Payer: CDPHP Medicare |
$1,515.52
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,867.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,276.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,276.80
|
| Rate for Payer: EmblemHealth Medicaid |
$3,276.80
|
| Rate for Payer: EmblemHealth Medicare |
$1,392.64
|
| Rate for Payer: EmblemHealth Select Care |
$2,662.40
|
| Rate for Payer: Fidelis Medicare |
$1,560.99
|
| Rate for Payer: Galaxy Health Commercial |
$2,662.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,515.52
|
| Rate for Payer: Humana Medicare |
$1,515.52
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,884.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,591.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$505.00
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$1,515.52
|
| Rate for Payer: WellCare Medicare |
$2,252.80
|
|
|
MRI ABDOMEN W/O & W/DYE
|
Facility
|
IP
|
$4,096.00
|
|
|
Service Code
|
HCPCS 74183
|
| Hospital Charge Code |
4230002
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,662.40 |
| Max. Negotiated Rate |
$2,662.40 |
| Rate for Payer: Cash Price |
$3,072.00
|
| Rate for Payer: Galaxy Health Commercial |
$2,662.40
|
|
|
MRI ANGIO CHEST W OR W/O DYE
|
Facility
|
IP
|
$2,324.00
|
|
|
Service Code
|
HCPCS 71555
|
| Hospital Charge Code |
4230044
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,510.60 |
| Max. Negotiated Rate |
$1,510.60 |
| Rate for Payer: Cash Price |
$1,743.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,510.60
|
|
|
MRI ANGIO CHEST W OR W/O DYE
|
Facility
|
OP
|
$2,324.00
|
|
|
Service Code
|
HCPCS 71555
|
| Hospital Charge Code |
4230044
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,069.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,743.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,743.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$859.88
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$1,743.00
|
| Rate for Payer: Cash Price |
$1,743.00
|
| Rate for Payer: Cash Price |
$1,743.00
|
| Rate for Payer: CDPHP Commercial |
$1,870.82
|
| Rate for Payer: CDPHP Medicare |
$859.88
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,626.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,859.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,859.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,859.20
|
| Rate for Payer: EmblemHealth Medicare |
$790.16
|
| Rate for Payer: EmblemHealth Select Care |
$1,510.60
|
| Rate for Payer: Fidelis Medicare |
$885.68
|
| Rate for Payer: Galaxy Health Commercial |
$1,510.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$859.88
|
| Rate for Payer: Humana Medicare |
$859.88
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,069.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$902.87
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$505.00
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$859.88
|
| Rate for Payer: WellCare Medicare |
$1,278.20
|
|
|
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 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 |
$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/DYE
|
Facility
|
IP
|
$1,864.00
|
|
|
Service Code
|
HCPCS 70552
|
| Hospital Charge Code |
4230029
|
|
Hospital Revenue Code
|
611
|
| 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
|
|
|
MRI BRAIN STEM W/O DYE
|
Facility
|
IP
|
$2,433.00
|
|
|
Service Code
|
HCPCS 70551 TC
|
| Hospital Charge Code |
4230008
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,581.45 |
| Max. Negotiated Rate |
$1,581.45 |
| Rate for Payer: Cash Price |
$1,824.75
|
| Rate for Payer: Galaxy Health Commercial |
$1,581.45
|
|
|
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 CBP/EPO/PPO/HMO/Network Access |
$1,703.10
|
| 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: EmblemHealth Select Care |
$1,581.45
|
| 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
|
IP
|
$3,779.00
|
|
|
Service Code
|
HCPCS 70553
|
| Hospital Charge Code |
4230009
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$2,456.35 |
| Max. Negotiated Rate |
$2,456.35 |
| Rate for Payer: Cash Price |
$2,834.25
|
| Rate for Payer: Galaxy Health Commercial |
$2,456.35
|
|
|
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 CBP/EPO/PPO/HMO/Network Access |
$2,645.30
|
| 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: EmblemHealth Select Care |
$2,456.35
|
| 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
|
IP
|
$701.00
|
|
|
Service Code
|
HCPCS 77047
|
| Hospital Charge Code |
4230212
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$455.65 |
| Max. Negotiated Rate |
$455.65 |
| Rate for Payer: Cash Price |
$525.75
|
| Rate for Payer: Galaxy Health Commercial |
$455.65
|
|
|
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 CBP/EPO/PPO/HMO/Network Access |
$490.70
|
| 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: EmblemHealth Select Care |
$455.65
|
| 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 CBP/EPO/PPO/HMO/Network Access |
$490.70
|
| 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: EmblemHealth Select Care |
$455.65
|
| 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
|
IP
|
$701.00
|
|
|
Service Code
|
HCPCS 77046
|
| Hospital Charge Code |
4230211
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$455.65 |
| Max. Negotiated Rate |
$455.65 |
| Rate for Payer: Cash Price |
$525.75
|
| Rate for Payer: Galaxy Health Commercial |
$455.65
|
|
|
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 CBP/EPO/PPO/HMO/Network Access |
$2,645.30
|
| 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: EmblemHealth Select Care |
$2,456.35
|
| 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
|
|
