|
MRA ABDOMEN W/ W/O DYE
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
HCPCS 74185 26
|
| Hospital Charge Code |
5230049
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$39.30 |
| Max. Negotiated Rate |
$209.60 |
| Rate for Payer: Aetna of NY Commercial |
$183.40
|
| Rate for Payer: Aetna of NY Medicare |
$120.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$104.80
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: CDPHP Medicare |
$96.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$209.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$209.60
|
| Rate for Payer: EmblemHealth Medicaid |
$209.60
|
| Rate for Payer: EmblemHealth Medicare |
$89.08
|
| Rate for Payer: Fidelis Medicare |
$104.80
|
| Rate for Payer: Galaxy Health Commercial |
$170.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$104.80
|
| Rate for Payer: Humana Medicare |
$104.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$183.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$120.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$196.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$147.51
|
| Rate for Payer: MVP Health Care of NY Medicare |
$110.04
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$39.30
|
| Rate for Payer: United Healthcare Medicare |
$104.80
|
| Rate for Payer: WellCare Medicare |
$144.10
|
|
|
MRA ABDOMEN W/ W/O DYE
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
HCPCS 74185 26
|
| Hospital Charge Code |
5230063
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$39.30 |
| Max. Negotiated Rate |
$209.60 |
| Rate for Payer: Aetna of NY Commercial |
$183.40
|
| Rate for Payer: Aetna of NY Medicare |
$120.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$104.80
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: CDPHP Medicare |
$96.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$209.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$209.60
|
| Rate for Payer: EmblemHealth Medicaid |
$209.60
|
| Rate for Payer: EmblemHealth Medicare |
$89.08
|
| Rate for Payer: Fidelis Medicare |
$104.80
|
| Rate for Payer: Galaxy Health Commercial |
$170.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$104.80
|
| Rate for Payer: Humana Medicare |
$104.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$183.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$120.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$196.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$147.51
|
| Rate for Payer: MVP Health Care of NY Medicare |
$110.04
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$39.30
|
| Rate for Payer: United Healthcare Medicare |
$104.80
|
| Rate for Payer: WellCare Medicare |
$144.10
|
|
|
MRA ABDOMEN W/ W/O DYE
|
Facility
|
IP
|
$2,389.00
|
|
|
Service Code
|
HCPCS 74185
|
| Hospital Charge Code |
4230049
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,552.85 |
| Max. Negotiated Rate |
$1,552.85 |
| Rate for Payer: Cash Price |
$1,791.75
|
| Rate for Payer: Galaxy Health Commercial |
$1,552.85
|
|
|
MRA ABDOMEN W/ W/O DYE
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
HCPCS 74185 26
|
| Hospital Charge Code |
5230064
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$39.30 |
| Max. Negotiated Rate |
$209.60 |
| Rate for Payer: Aetna of NY Commercial |
$183.40
|
| Rate for Payer: Aetna of NY Medicare |
$120.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$104.80
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: CDPHP Medicare |
$96.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$209.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$209.60
|
| Rate for Payer: EmblemHealth Medicaid |
$209.60
|
| Rate for Payer: EmblemHealth Medicare |
$89.08
|
| Rate for Payer: Fidelis Medicare |
$104.80
|
| Rate for Payer: Galaxy Health Commercial |
$170.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$104.80
|
| Rate for Payer: Humana Medicare |
$104.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$183.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$120.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$196.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$147.51
|
| Rate for Payer: MVP Health Care of NY Medicare |
$110.04
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$39.30
|
| Rate for Payer: United Healthcare Medicare |
$104.80
|
| Rate for Payer: WellCare Medicare |
$144.10
|
|
|
MRA ABDOMEN W/ W/O DYE
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
HCPCS 74185 26
|
| Hospital Charge Code |
5230209
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$39.30 |
| Max. Negotiated Rate |
$209.60 |
| Rate for Payer: Aetna of NY Commercial |
$183.40
|
| Rate for Payer: Aetna of NY Medicare |
$120.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$104.80
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: CDPHP Medicare |
$96.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$209.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$209.60
|
| Rate for Payer: EmblemHealth Medicaid |
$209.60
|
| Rate for Payer: EmblemHealth Medicare |
$89.08
|
| Rate for Payer: Fidelis Medicare |
$104.80
|
| Rate for Payer: Galaxy Health Commercial |
$170.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$104.80
|
| Rate for Payer: Humana Medicare |
$104.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$183.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$120.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$196.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$147.51
|
| Rate for Payer: MVP Health Care of NY Medicare |
$110.04
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$39.30
|
| Rate for Payer: United Healthcare Medicare |
$104.80
|
| Rate for Payer: WellCare Medicare |
$144.10
|
|
|
MRA ABD W CONTRAST
|
Facility
|
IP
|
$2,329.00
|
|
|
Service Code
|
HCPCS C8900
|
| Hospital Charge Code |
4230063
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,513.85 |
| Max. Negotiated Rate |
$1,513.85 |
| Rate for Payer: Cash Price |
$1,746.75
|
| Rate for Payer: Galaxy Health Commercial |
$1,513.85
|
|
|
MRA ABD W CONTRAST
|
Facility
|
OP
|
$2,329.00
|
|
|
Service Code
|
HCPCS C8900
|
| Hospital Charge Code |
4230063
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$349.35 |
| Max. Negotiated Rate |
$2,328.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,071.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$931.60
|
| Rate for Payer: Cash Price |
$1,746.75
|
| Rate for Payer: Cash Price |
$1,746.75
|
| Rate for Payer: Cash Price |
$1,746.75
|
| Rate for Payer: CDPHP Medicare |
$861.73
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,630.30
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,863.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,863.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,863.20
|
| Rate for Payer: EmblemHealth Medicare |
$791.86
|
| Rate for Payer: EmblemHealth Select Care |
$1,513.85
|
| Rate for Payer: Fidelis Medicare |
$931.60
|
| Rate for Payer: Galaxy Health Commercial |
$1,513.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$931.60
|
| Rate for Payer: Humana Medicare |
$931.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,071.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,334.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$964.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$978.18
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$349.35
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$931.60
|
| Rate for Payer: WellCare Medicare |
$1,280.95
|
|
|
MRA ABD WO CONTRAST
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C8901
|
| Hospital Charge Code |
4230209
|
|
Hospital Revenue Code
|
619
|
| Min. Negotiated Rate |
$1,110.20 |
| Max. Negotiated Rate |
$1,110.20 |
| Rate for Payer: Cash Price |
$1,281.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,110.20
|
|
|
MRA ABD WO CONTRAST
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C8901
|
| Hospital Charge Code |
4230209
|
|
Hospital Revenue Code
|
619
|
| Min. Negotiated Rate |
$256.20 |
| Max. Negotiated Rate |
$2,328.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$785.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$683.20
|
| Rate for Payer: Cash Price |
$1,281.00
|
| Rate for Payer: Cash Price |
$1,281.00
|
| Rate for Payer: Cash Price |
$1,281.00
|
| Rate for Payer: CDPHP Medicare |
$631.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,195.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,366.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,366.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,366.40
|
| Rate for Payer: EmblemHealth Medicare |
$580.72
|
| Rate for Payer: EmblemHealth Select Care |
$1,110.20
|
| Rate for Payer: Fidelis Medicare |
$683.20
|
| Rate for Payer: Galaxy Health Commercial |
$1,110.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$683.20
|
| Rate for Payer: Humana Medicare |
$683.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$785.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,334.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$964.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$717.36
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$256.20
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$683.20
|
| Rate for Payer: WellCare Medicare |
$939.40
|
|
|
MRA ABD W/WO CONTRAST
|
Facility
|
IP
|
$2,847.00
|
|
|
Service Code
|
HCPCS C8902
|
| Hospital Charge Code |
4230064
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,850.55 |
| Max. Negotiated Rate |
$1,850.55 |
| Rate for Payer: Cash Price |
$2,135.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,850.55
|
|
|
MRA ABD W/WO CONTRAST
|
Facility
|
OP
|
$2,847.00
|
|
|
Service Code
|
HCPCS C8902
|
| Hospital Charge Code |
4230064
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$427.05 |
| Max. Negotiated Rate |
$2,328.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,309.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,138.80
|
| 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 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 |
$1,138.80
|
| Rate for Payer: Galaxy Health Commercial |
$1,850.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,138.80
|
| Rate for Payer: Humana Medicare |
$1,138.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,309.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,334.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$964.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,195.74
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$427.05
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$1,138.80
|
| Rate for Payer: WellCare Medicare |
$1,565.85
|
|
|
MRA, BREAST, W/O CONTRAST, UNI
|
Facility
|
IP
|
$211.00
|
|
|
Service Code
|
HCPCS 77046 26
|
| Hospital Charge Code |
5230211
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$137.15 |
| Max. Negotiated Rate |
$137.15 |
| Rate for Payer: Cash Price |
$158.25
|
| Rate for Payer: Galaxy Health Commercial |
$137.15
|
|
|
MRA, BREAST, W/O CONTRAST, UNI
|
Facility
|
OP
|
$211.00
|
|
|
Service Code
|
HCPCS 77046 26
|
| Hospital Charge Code |
5230211
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$31.65 |
| Max. Negotiated Rate |
$168.80 |
| Rate for Payer: Aetna of NY Commercial |
$147.70
|
| Rate for Payer: Aetna of NY Medicare |
$97.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$84.40
|
| Rate for Payer: Cash Price |
$158.25
|
| Rate for Payer: CDPHP Medicare |
$78.07
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$168.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$168.80
|
| Rate for Payer: EmblemHealth Medicaid |
$168.80
|
| Rate for Payer: EmblemHealth Medicare |
$71.74
|
| Rate for Payer: Fidelis Medicare |
$84.40
|
| Rate for Payer: Galaxy Health Commercial |
$137.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$84.40
|
| Rate for Payer: Humana Medicare |
$84.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$147.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$97.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$158.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$118.79
|
| Rate for Payer: MVP Health Care of NY Medicare |
$88.62
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$31.65
|
| Rate for Payer: United Healthcare Medicare |
$84.40
|
| Rate for Payer: WellCare Medicare |
$116.05
|
|
|
MRA CHEST W CONTRAST
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C8909
|
| Hospital Charge Code |
4230074
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$256.20 |
| Max. Negotiated Rate |
$2,328.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$785.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$683.20
|
| Rate for Payer: Cash Price |
$1,281.00
|
| Rate for Payer: Cash Price |
$1,281.00
|
| Rate for Payer: Cash Price |
$1,281.00
|
| Rate for Payer: CDPHP Medicare |
$631.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,195.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,366.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,366.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,366.40
|
| Rate for Payer: EmblemHealth Medicare |
$580.72
|
| Rate for Payer: EmblemHealth Select Care |
$1,110.20
|
| Rate for Payer: Fidelis Medicare |
$683.20
|
| Rate for Payer: Galaxy Health Commercial |
$1,110.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$683.20
|
| Rate for Payer: Humana Medicare |
$683.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$785.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,334.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$964.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$717.36
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$256.20
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$683.20
|
| Rate for Payer: WellCare Medicare |
$939.40
|
|
|
MRA CHEST W CONTRAST
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C8909
|
| Hospital Charge Code |
4230074
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,110.20 |
| Max. Negotiated Rate |
$1,110.20 |
| Rate for Payer: Cash Price |
$1,281.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,110.20
|
|
|
MRA CHEST WO CONTR
|
Facility
|
OP
|
$1,915.00
|
|
|
Service Code
|
HCPCS C8910
|
| Hospital Charge Code |
4230208
|
|
Hospital Revenue Code
|
619
|
| Min. Negotiated Rate |
$287.25 |
| Max. Negotiated Rate |
$2,328.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$880.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$766.00
|
| Rate for Payer: Cash Price |
$1,436.25
|
| Rate for Payer: Cash Price |
$1,436.25
|
| Rate for Payer: Cash Price |
$1,436.25
|
| Rate for Payer: CDPHP Medicare |
$708.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,340.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,532.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,532.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,532.00
|
| Rate for Payer: EmblemHealth Medicare |
$651.10
|
| Rate for Payer: EmblemHealth Select Care |
$1,244.75
|
| Rate for Payer: Fidelis Medicare |
$766.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,244.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$766.00
|
| Rate for Payer: Humana Medicare |
$766.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$880.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,334.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$964.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$804.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$287.25
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$766.00
|
| Rate for Payer: WellCare Medicare |
$1,053.25
|
|
|
MRA CHEST WO CONTR
|
Facility
|
IP
|
$1,915.00
|
|
|
Service Code
|
HCPCS C8910
|
| Hospital Charge Code |
4230208
|
|
Hospital Revenue Code
|
619
|
| Min. Negotiated Rate |
$1,244.75 |
| Max. Negotiated Rate |
$1,244.75 |
| Rate for Payer: Cash Price |
$1,436.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,244.75
|
|
|
MRA CHEST W/WO CONTR
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C8911
|
| Hospital Charge Code |
4230073
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,110.20 |
| Max. Negotiated Rate |
$1,110.20 |
| Rate for Payer: Cash Price |
$1,281.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,110.20
|
|
|
MRA CHEST W/WO CONTR
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C8911
|
| Hospital Charge Code |
4230073
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$256.20 |
| Max. Negotiated Rate |
$2,328.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$785.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$683.20
|
| Rate for Payer: Cash Price |
$1,281.00
|
| Rate for Payer: Cash Price |
$1,281.00
|
| Rate for Payer: Cash Price |
$1,281.00
|
| Rate for Payer: CDPHP Medicare |
$631.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,195.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,366.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,366.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,366.40
|
| Rate for Payer: EmblemHealth Medicare |
$580.72
|
| Rate for Payer: EmblemHealth Select Care |
$1,110.20
|
| Rate for Payer: Fidelis Medicare |
$683.20
|
| Rate for Payer: Galaxy Health Commercial |
$1,110.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$683.20
|
| Rate for Payer: Humana Medicare |
$683.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$785.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,334.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$964.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$717.36
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$256.20
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$683.20
|
| Rate for Payer: WellCare Medicare |
$939.40
|
|
|
MRA HEAD W/ DYE
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 70545 26
|
| Hospital Charge Code |
5230035
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$113.75 |
| Max. Negotiated Rate |
$113.75 |
| Rate for Payer: Cash Price |
$131.25
|
| Rate for Payer: Galaxy Health Commercial |
$113.75
|
|
|
MRA HEAD W/ DYE
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 70545 26
|
| Hospital Charge Code |
5230035
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna of NY Commercial |
$122.50
|
| Rate for Payer: Aetna of NY Medicare |
$80.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$70.00
|
| Rate for Payer: Cash Price |
$131.25
|
| Rate for Payer: CDPHP Medicare |
$64.75
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$140.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$140.00
|
| Rate for Payer: EmblemHealth Medicaid |
$140.00
|
| Rate for Payer: EmblemHealth Medicare |
$59.50
|
| Rate for Payer: Fidelis Medicare |
$70.00
|
| Rate for Payer: Galaxy Health Commercial |
$113.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$70.00
|
| Rate for Payer: Humana Medicare |
$70.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$122.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$80.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$131.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$98.53
|
| Rate for Payer: MVP Health Care of NY Medicare |
$73.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$26.25
|
| Rate for Payer: United Healthcare Medicare |
$70.00
|
| Rate for Payer: WellCare Medicare |
$96.25
|
|
|
MRA HEAD W/DYE
|
Facility
|
OP
|
$2,226.00
|
|
|
Service Code
|
HCPCS 70545
|
| Hospital Charge Code |
4230035
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$333.90 |
| Max. Negotiated Rate |
$2,328.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,023.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$890.40
|
| Rate for Payer: Cash Price |
$1,669.50
|
| Rate for Payer: Cash Price |
$1,669.50
|
| Rate for Payer: Cash Price |
$1,669.50
|
| Rate for Payer: CDPHP Medicare |
$823.62
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,558.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,780.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,780.80
|
| Rate for Payer: EmblemHealth Medicaid |
$1,780.80
|
| Rate for Payer: EmblemHealth Medicare |
$756.84
|
| Rate for Payer: EmblemHealth Select Care |
$1,446.90
|
| Rate for Payer: Fidelis Medicare |
$890.40
|
| Rate for Payer: Galaxy Health Commercial |
$1,446.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$890.40
|
| Rate for Payer: Humana Medicare |
$890.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,023.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,334.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$964.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$934.92
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$333.90
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$890.40
|
| Rate for Payer: WellCare Medicare |
$1,224.30
|
|
|
MRA HEAD W/DYE
|
Facility
|
IP
|
$2,226.00
|
|
|
Service Code
|
HCPCS 70545
|
| Hospital Charge Code |
4230035
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,446.90 |
| Max. Negotiated Rate |
$1,446.90 |
| Rate for Payer: Cash Price |
$1,669.50
|
| Rate for Payer: Galaxy Health Commercial |
$1,446.90
|
|
|
MRA HEAD W/O DYE
|
Facility
|
IP
|
$2,620.00
|
|
|
Service Code
|
HCPCS 70544
|
| Hospital Charge Code |
4230034
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,703.00 |
| Max. Negotiated Rate |
$1,703.00 |
| Rate for Payer: Cash Price |
$1,965.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,703.00
|
|
|
MRA HEAD W/O DYE
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 70544 26
|
| Hospital Charge Code |
5230034
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna of NY Commercial |
$122.50
|
| Rate for Payer: Aetna of NY Medicare |
$80.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$70.00
|
| Rate for Payer: Cash Price |
$131.25
|
| Rate for Payer: CDPHP Medicare |
$64.75
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$140.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$140.00
|
| Rate for Payer: EmblemHealth Medicaid |
$140.00
|
| Rate for Payer: EmblemHealth Medicare |
$59.50
|
| Rate for Payer: Fidelis Medicare |
$70.00
|
| Rate for Payer: Galaxy Health Commercial |
$113.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$70.00
|
| Rate for Payer: Humana Medicare |
$70.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$122.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$80.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$131.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$98.53
|
| Rate for Payer: MVP Health Care of NY Medicare |
$73.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$26.25
|
| Rate for Payer: United Healthcare Medicare |
$70.00
|
| Rate for Payer: WellCare Medicare |
$96.25
|
|
