|
MRI THORACIC SPINE W/O & W/DYE
|
Facility
|
OP
|
$3,986.00
|
|
|
Service Code
|
HCPCS 72157
|
| Hospital Charge Code |
4230013
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$505.00 |
| 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 |
$505.00
|
| 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
|
|
|
MRI UPPER EXT; ANY JOINT W DYE
|
Facility
|
OP
|
$3,572.00
|
|
|
Service Code
|
HCPCS 73222
|
| Hospital Charge Code |
4230022
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$2,875.46 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,643.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,679.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,679.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,321.64
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$2,679.00
|
| Rate for Payer: Cash Price |
$2,679.00
|
| Rate for Payer: Cash Price |
$2,679.00
|
| Rate for Payer: CDPHP Commercial |
$2,875.46
|
| Rate for Payer: CDPHP Medicare |
$1,321.64
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,500.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,857.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,857.60
|
| Rate for Payer: EmblemHealth Medicaid |
$2,857.60
|
| Rate for Payer: EmblemHealth Medicare |
$1,214.48
|
| Rate for Payer: EmblemHealth Select Care |
$2,321.80
|
| Rate for Payer: Fidelis Medicare |
$1,361.29
|
| Rate for Payer: Galaxy Health Commercial |
$2,321.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,321.64
|
| Rate for Payer: Humana Medicare |
$1,321.64
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,643.12
|
| 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 |
$1,387.72
|
| 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 |
$1,321.64
|
| Rate for Payer: WellCare Medicare |
$1,964.60
|
|
|
MRI UPPER EXT; ANY JOINT W DYE
|
Facility
|
IP
|
$3,572.00
|
|
|
Service Code
|
HCPCS 73222
|
| Hospital Charge Code |
4230022
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,321.80 |
| Max. Negotiated Rate |
$2,321.80 |
| Rate for Payer: Cash Price |
$2,679.00
|
| Rate for Payer: Galaxy Health Commercial |
$2,321.80
|
|
|
MRI UPPER EXT; ANY JOINT W/O DYE
|
Facility
|
OP
|
$2,240.00
|
|
|
Service Code
|
HCPCS 73221 TC
|
| Hospital Charge Code |
4230021
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$761.60 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,030.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,680.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,680.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$828.80
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$1,680.00
|
| Rate for Payer: Cash Price |
$1,680.00
|
| Rate for Payer: Cash Price |
$1,680.00
|
| Rate for Payer: CDPHP Commercial |
$1,803.20
|
| Rate for Payer: CDPHP Medicare |
$828.80
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,568.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,792.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,792.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,792.00
|
| Rate for Payer: EmblemHealth Medicare |
$761.60
|
| Rate for Payer: EmblemHealth Select Care |
$1,456.00
|
| Rate for Payer: Fidelis Medicare |
$853.66
|
| Rate for Payer: Galaxy Health Commercial |
$1,456.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$828.80
|
| Rate for Payer: Humana Medicare |
$828.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,030.40
|
| 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 |
$870.24
|
| 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 |
$828.80
|
| Rate for Payer: WellCare Medicare |
$1,232.00
|
|
|
MRI UPPER EXT; ANY JOINT W/O DYE
|
Facility
|
IP
|
$2,240.00
|
|
|
Service Code
|
HCPCS 73221 TC
|
| Hospital Charge Code |
4230021
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,456.00 |
| Max. Negotiated Rate |
$1,456.00 |
| Rate for Payer: Cash Price |
$1,680.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,456.00
|
|
|
MRI UPPER EXT; ANY JOINT W/O & W/DYE
|
Facility
|
IP
|
$4,400.00
|
|
|
Service Code
|
HCPCS 73223
|
| Hospital Charge Code |
4230023
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,860.00 |
| Max. Negotiated Rate |
$2,860.00 |
| Rate for Payer: Cash Price |
$3,300.00
|
| Rate for Payer: Galaxy Health Commercial |
$2,860.00
|
|
|
MRI UPPER EXT; ANY JOINT W/O & W/DYE
|
Facility
|
OP
|
$4,400.00
|
|
|
Service Code
|
HCPCS 73223
|
| Hospital Charge Code |
4230023
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$3,542.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,024.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,300.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3,300.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,628.00
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$3,300.00
|
| Rate for Payer: Cash Price |
$3,300.00
|
| Rate for Payer: Cash Price |
$3,300.00
|
| Rate for Payer: CDPHP Commercial |
$3,542.00
|
| Rate for Payer: CDPHP Medicare |
$1,628.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3,080.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,520.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,520.00
|
| Rate for Payer: EmblemHealth Medicaid |
$3,520.00
|
| Rate for Payer: EmblemHealth Medicare |
$1,496.00
|
| Rate for Payer: EmblemHealth Select Care |
$2,860.00
|
| Rate for Payer: Fidelis Medicare |
$1,676.84
|
| Rate for Payer: Galaxy Health Commercial |
$2,860.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,628.00
|
| Rate for Payer: Humana Medicare |
$1,628.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,024.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,709.40
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$505.00
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$1,628.00
|
| Rate for Payer: WellCare Medicare |
$2,420.00
|
|
|
MRI UPPER EXT; NON JOINT W/ DYE
|
Facility
|
OP
|
$3,209.00
|
|
|
Service Code
|
HCPCS 73219
|
| Hospital Charge Code |
4230025
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$2,583.24 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,476.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,406.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,406.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,187.33
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$2,406.75
|
| Rate for Payer: Cash Price |
$2,406.75
|
| Rate for Payer: Cash Price |
$2,406.75
|
| Rate for Payer: CDPHP Commercial |
$2,583.24
|
| Rate for Payer: CDPHP Medicare |
$1,187.33
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,246.30
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,567.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,567.20
|
| Rate for Payer: EmblemHealth Medicaid |
$2,567.20
|
| Rate for Payer: EmblemHealth Medicare |
$1,091.06
|
| Rate for Payer: EmblemHealth Select Care |
$2,085.85
|
| Rate for Payer: Fidelis Medicare |
$1,222.95
|
| Rate for Payer: Galaxy Health Commercial |
$2,085.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,187.33
|
| Rate for Payer: Humana Medicare |
$1,187.33
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,476.14
|
| 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 |
$1,246.70
|
| 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 |
$1,187.33
|
| Rate for Payer: WellCare Medicare |
$1,764.95
|
|
|
MRI UPPER EXT; NON JOINT W/ DYE
|
Facility
|
IP
|
$3,209.00
|
|
|
Service Code
|
HCPCS 73219
|
| Hospital Charge Code |
4230025
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,085.85 |
| Max. Negotiated Rate |
$2,085.85 |
| Rate for Payer: Cash Price |
$2,406.75
|
| Rate for Payer: Galaxy Health Commercial |
$2,085.85
|
|
|
MRI UPPER EXT; NON JOINT W/O DYE
|
Facility
|
OP
|
$3,427.00
|
|
|
Service Code
|
HCPCS 73218
|
| Hospital Charge Code |
4230024
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$2,758.74 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,576.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,570.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,570.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,267.99
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$2,570.25
|
| Rate for Payer: Cash Price |
$2,570.25
|
| Rate for Payer: Cash Price |
$2,570.25
|
| Rate for Payer: CDPHP Commercial |
$2,758.74
|
| Rate for Payer: CDPHP Medicare |
$1,267.99
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,398.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,741.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,741.60
|
| Rate for Payer: EmblemHealth Medicaid |
$2,741.60
|
| Rate for Payer: EmblemHealth Medicare |
$1,165.18
|
| Rate for Payer: EmblemHealth Select Care |
$2,227.55
|
| Rate for Payer: Fidelis Medicare |
$1,306.03
|
| Rate for Payer: Galaxy Health Commercial |
$2,227.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,267.99
|
| Rate for Payer: Humana Medicare |
$1,267.99
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,576.42
|
| 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 |
$1,331.39
|
| 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 |
$1,267.99
|
| Rate for Payer: WellCare Medicare |
$1,884.85
|
|
|
MRI UPPER EXT; NON JOINT W/O DYE
|
Facility
|
IP
|
$3,427.00
|
|
|
Service Code
|
HCPCS 73218
|
| Hospital Charge Code |
4230024
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,227.55 |
| Max. Negotiated Rate |
$2,227.55 |
| Rate for Payer: Cash Price |
$2,570.25
|
| Rate for Payer: Galaxy Health Commercial |
$2,227.55
|
|
|
MRI UPPER EXT; NON JOINT W/O & W/DYE
|
Facility
|
IP
|
$4,400.00
|
|
|
Service Code
|
HCPCS 73220
|
| Hospital Charge Code |
4230026
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,860.00 |
| Max. Negotiated Rate |
$2,860.00 |
| Rate for Payer: Cash Price |
$3,300.00
|
| Rate for Payer: Galaxy Health Commercial |
$2,860.00
|
|
|
MRI UPPER EXT; NON JOINT W/O & W/DYE
|
Facility
|
OP
|
$4,400.00
|
|
|
Service Code
|
HCPCS 73220
|
| Hospital Charge Code |
4230026
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$3,542.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,024.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,300.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3,300.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,628.00
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$3,300.00
|
| Rate for Payer: Cash Price |
$3,300.00
|
| Rate for Payer: Cash Price |
$3,300.00
|
| Rate for Payer: CDPHP Commercial |
$3,542.00
|
| Rate for Payer: CDPHP Medicare |
$1,628.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3,080.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,520.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,520.00
|
| Rate for Payer: EmblemHealth Medicaid |
$3,520.00
|
| Rate for Payer: EmblemHealth Medicare |
$1,496.00
|
| Rate for Payer: EmblemHealth Select Care |
$2,860.00
|
| Rate for Payer: Fidelis Medicare |
$1,676.84
|
| Rate for Payer: Galaxy Health Commercial |
$2,860.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,628.00
|
| Rate for Payer: Humana Medicare |
$1,628.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,024.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,709.40
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$505.00
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$1,628.00
|
| Rate for Payer: WellCare Medicare |
$2,420.00
|
|
|
MUGA; MULTI W WM & EF
|
Facility
|
IP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 78473
|
| Hospital Charge Code |
4210098
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$767.00 |
| Max. Negotiated Rate |
$767.00 |
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Galaxy Health Commercial |
$767.00
|
|
|
MUGA; MULTI W WM & EF
|
Facility
|
OP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 78473
|
| Hospital Charge Code |
4210098
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$151.50 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of NY Commercial |
$826.00
|
| Rate for Payer: Aetna of NY Medicare |
$542.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$885.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$885.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$436.60
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$590.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: CDPHP Commercial |
$949.90
|
| Rate for Payer: CDPHP Medicare |
$436.60
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$826.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$944.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$944.00
|
| Rate for Payer: EmblemHealth Medicaid |
$944.00
|
| Rate for Payer: EmblemHealth Medicare |
$401.20
|
| Rate for Payer: EmblemHealth Select Care |
$767.00
|
| Rate for Payer: Fidelis Medicare |
$449.70
|
| Rate for Payer: Galaxy Health Commercial |
$767.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$436.60
|
| Rate for Payer: Humana Medicare |
$436.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$826.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$542.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$885.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$664.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$458.43
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,500.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$151.50
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$436.60
|
| Rate for Payer: WellCare Medicare |
$649.00
|
|
|
MUGA SGL W RV EF BY 1ST PASS
|
Facility
|
OP
|
$379.00
|
|
|
Service Code
|
HCPCS 78496
|
| Hospital Charge Code |
4210082
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$128.86 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of NY Commercial |
$265.30
|
| Rate for Payer: Aetna of NY Medicare |
$174.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$284.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$284.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$140.23
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$189.50
|
| Rate for Payer: Cash Price |
$284.25
|
| Rate for Payer: Cash Price |
$284.25
|
| Rate for Payer: CDPHP Commercial |
$305.10
|
| Rate for Payer: CDPHP Medicare |
$140.23
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$265.30
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$303.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$303.20
|
| Rate for Payer: EmblemHealth Medicaid |
$303.20
|
| Rate for Payer: EmblemHealth Medicare |
$128.86
|
| Rate for Payer: EmblemHealth Select Care |
$246.35
|
| Rate for Payer: Fidelis Medicare |
$144.44
|
| Rate for Payer: Galaxy Health Commercial |
$246.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$140.23
|
| Rate for Payer: Humana Medicare |
$140.23
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$265.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$174.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$284.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$213.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$147.24
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,500.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$167.66
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$140.23
|
| Rate for Payer: WellCare Medicare |
$208.45
|
|
|
MUGA SGL W RV EF BY 1ST PASS
|
Facility
|
IP
|
$379.00
|
|
|
Service Code
|
HCPCS 78496
|
| Hospital Charge Code |
4210082
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$246.35 |
| Max. Negotiated Rate |
$246.35 |
| Rate for Payer: Cash Price |
$284.25
|
| Rate for Payer: Galaxy Health Commercial |
$246.35
|
|
|
MUGA; SGL W WM & EF
|
Facility
|
IP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 78472
|
| Hospital Charge Code |
4211249
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$767.00 |
| Max. Negotiated Rate |
$767.00 |
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Galaxy Health Commercial |
$767.00
|
|
|
MUGA; SGL W WM & EF
|
Facility
|
OP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 78472
|
| Hospital Charge Code |
4211249
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$151.50 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of NY Commercial |
$826.00
|
| Rate for Payer: Aetna of NY Medicare |
$542.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$885.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$885.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$436.60
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$590.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: CDPHP Commercial |
$949.90
|
| Rate for Payer: CDPHP Medicare |
$436.60
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$826.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$944.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$944.00
|
| Rate for Payer: EmblemHealth Medicaid |
$944.00
|
| Rate for Payer: EmblemHealth Medicare |
$401.20
|
| Rate for Payer: EmblemHealth Select Care |
$767.00
|
| Rate for Payer: Fidelis Medicare |
$449.70
|
| Rate for Payer: Galaxy Health Commercial |
$767.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$436.60
|
| Rate for Payer: Humana Medicare |
$436.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$826.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$542.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$885.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$664.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$458.43
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,500.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$151.50
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$436.60
|
| Rate for Payer: WellCare Medicare |
$649.00
|
|
|
MUGA SPECT W WM & EF
|
Facility
|
OP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 78494
|
| Hospital Charge Code |
4210083
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$187.86 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of NY Commercial |
$826.00
|
| Rate for Payer: Aetna of NY Medicare |
$542.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$885.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$885.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$436.60
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$590.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: CDPHP Commercial |
$949.90
|
| Rate for Payer: CDPHP Medicare |
$436.60
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$826.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$944.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$944.00
|
| Rate for Payer: EmblemHealth Medicaid |
$944.00
|
| Rate for Payer: EmblemHealth Medicare |
$401.20
|
| Rate for Payer: EmblemHealth Select Care |
$767.00
|
| Rate for Payer: Fidelis Medicare |
$449.70
|
| Rate for Payer: Galaxy Health Commercial |
$767.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$436.60
|
| Rate for Payer: Humana Medicare |
$436.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$826.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$542.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$885.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$664.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$458.43
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,500.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$187.86
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$436.60
|
| Rate for Payer: WellCare Medicare |
$649.00
|
|
|
MUGA SPECT W WM & EF
|
Facility
|
IP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 78494
|
| Hospital Charge Code |
4210083
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$767.00 |
| Max. Negotiated Rate |
$767.00 |
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Galaxy Health Commercial |
$767.00
|
|
|
MULTIPLE AREA STATIC BONE
|
Facility
|
OP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 78305
|
| Hospital Charge Code |
4210003
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$60.60 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of NY Commercial |
$826.00
|
| Rate for Payer: Aetna of NY Medicare |
$542.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$885.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$885.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$436.60
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$590.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: CDPHP Commercial |
$949.90
|
| Rate for Payer: CDPHP Medicare |
$436.60
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$826.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$944.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$944.00
|
| Rate for Payer: EmblemHealth Medicaid |
$944.00
|
| Rate for Payer: EmblemHealth Medicare |
$401.20
|
| Rate for Payer: EmblemHealth Select Care |
$767.00
|
| Rate for Payer: Fidelis Medicare |
$449.70
|
| Rate for Payer: Galaxy Health Commercial |
$767.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$436.60
|
| Rate for Payer: Humana Medicare |
$436.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$826.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$542.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$885.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$664.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$458.43
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,500.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$60.60
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$436.60
|
| Rate for Payer: WellCare Medicare |
$649.00
|
|
|
MULTIPLE AREA STATIC BONE
|
Facility
|
IP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 78305
|
| Hospital Charge Code |
4210003
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$767.00 |
| Max. Negotiated Rate |
$767.00 |
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Galaxy Health Commercial |
$767.00
|
|
|
MULTIVITAMIN SDV 5X10ML
|
Facility
|
IP
|
$32.70
|
|
|
Service Code
|
NDC 54643564901
|
| Hospital Charge Code |
4400388
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.98 |
| Max. Negotiated Rate |
$21.26 |
| Rate for Payer: Cash Price |
$24.53
|
| Rate for Payer: Galaxy Health Commercial |
$21.26
|
| Rate for Payer: WellCare Medicare |
$17.98
|
|
|
MULTIVITAMIN SDV 5X10ML
|
Facility
|
OP
|
$32.70
|
|
|
Service Code
|
NDC 54643564901
|
| Hospital Charge Code |
4400388
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.12 |
| Max. Negotiated Rate |
$26.32 |
| Rate for Payer: Aetna of NY Commercial |
$22.89
|
| Rate for Payer: Aetna of NY Medicare |
$15.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$24.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$24.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.10
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$16.35
|
| Rate for Payer: Cash Price |
$24.53
|
| Rate for Payer: CDPHP Commercial |
$26.32
|
| Rate for Payer: CDPHP Medicare |
$12.10
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$26.16
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.16
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$26.16
|
| Rate for Payer: EmblemHealth Medicaid |
$26.16
|
| Rate for Payer: EmblemHealth Medicare |
$11.12
|
| Rate for Payer: EmblemHealth Select Care |
$23.54
|
| Rate for Payer: Fidelis Medicare |
$12.46
|
| Rate for Payer: Galaxy Health Commercial |
$21.26
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.10
|
| Rate for Payer: Humana Medicare |
$12.10
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$22.89
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.52
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$18.41
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.70
|
| Rate for Payer: United Healthcare Medicare |
$12.10
|
| Rate for Payer: WellCare Medicare |
$17.98
|
|
